Provider Demographics
NPI:1194908632
Name:FLAT CREEK ENTERPRISES, LLC
Entity type:Organization
Organization Name:FLAT CREEK ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-773-0520
Mailing Address - Street 1:PO BOX 8235
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-8235
Mailing Address - Country:US
Mailing Address - Phone:417-864-5455
Mailing Address - Fax:417-864-5781
Practice Address - Street 1:1410 E KEARNEY ST
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4102
Practice Address - Country:US
Practice Address - Phone:417-773-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114747261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505488601Medicaid
MODG9102OtherRAILROAD MEDICARE
MO505488601Medicaid
MO=========OtherTRICARE