Provider Demographics
NPI:1497942288
Name:SAHARAH, P.C.
Entity type:Organization
Organization Name:SAHARAH, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:CREEDEN
Authorized Official - Last Name:BROWNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:573-317-0111
Mailing Address - Street 1:396 W US HIGHWAY 54 STE 103
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6942
Mailing Address - Country:US
Mailing Address - Phone:573-317-0111
Mailing Address - Fax:573-317-1115
Practice Address - Street 1:396 W US HIGHWAY 54 STE 103
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6942
Practice Address - Country:US
Practice Address - Phone:573-317-0111
Practice Address - Fax:573-317-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO48547500Medicaid
MO48547500Medicaid