National Provider Identifier Database

COUNTRY CARE FAMILY CLINIC LLC
Primary Care


Contact Information

COUNTRY CARE FAMILY CLINIC, LLC
3 E CLEVELAND AVE
ELLSINORE, MO63937
Phone: 573-322-0404
Fax: 573-322-0168
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for COUNTRY CARE FAMILY CLINIC, LLC

NPI Number 1306313051
Legal business name
LBN
COUNTRY CARE FAMILY CLINIC, LLC
Authorized official LAURA NANCE - (NURSE PRACTITIONER/ OFFICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 10/31/2018
Last updated 10/31/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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