Provider Demographics
NPI:1962698134
Name:AUDRAIN HEALTH CARE, INC.
Entity type:Organization
Organization Name:AUDRAIN HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-8108
Mailing Address - Street 1:600 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3724
Mailing Address - Country:US
Mailing Address - Phone:573-581-8500
Mailing Address - Fax:573-581-5397
Practice Address - Street 1:600 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3724
Practice Address - Country:US
Practice Address - Phone:573-581-8500
Practice Address - Fax:573-581-5397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDRAIN HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD31094207R00000X
MO2001014673207R00000X
MOR9143207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty