Basic Information
| Provider Information | |||||||||
| NPI: | 1225006224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAKE CARE HEALTH MISSOURI, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 BARR HARBOR DRIVE | ||||||||
| Address2: | SUITE 550, FIVE TOWER BRIDGE | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668253227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 N. E. BARRY ROAD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668253227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PETRICK | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4843513220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.