Provider Demographics
NPI:1548296304
Name:PREFERRED HOSPICE OF MISSOURI LLC
Entity type:Organization
Organization Name:PREFERRED HOSPICE OF MISSOURI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:1220 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4827
Mailing Address - Country:US
Mailing Address - Phone:573-481-9625
Mailing Address - Fax:573-481-9639
Practice Address - Street 1:423 BUSINESS HIGHWAY 60 WEST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1121
Practice Address - Country:US
Practice Address - Phone:573-614-4774
Practice Address - Fax:573-614-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139-HO251G00000X
MO139-3HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200884OtherBLUE CROSS BLUE SHIELD
MO826195208Medicaid
MO1548296304Medicaid
MO1548296304Medicaid