Provider Demographics
NPI:1215491071
Name:EXTENDED HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:EXTENDED HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-359-2930
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0544
Mailing Address - Country:US
Mailing Address - Phone:573-359-2930
Mailing Address - Fax:
Practice Address - Street 1:105 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1300
Practice Address - Country:US
Practice Address - Phone:573-359-2930
Practice Address - Fax:573-359-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty