Organization
AUDRAIN PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
620 E MONROE ST, MEXICO, MO 65265-2919
(573) 582-5000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
MO
363A00000X
Physician Assistant
—
MO
363L00000X
Nurse Practitioner
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457743148
—
MO
Enumeration date
03/04/2015
Last updated
03/23/2022
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