Organization
IMMEDIATE HEALTHCARE KINGS HIGHWAY
Active
Other names
IMMEDIATE HEALTHCARE KINGS HIGHWAY
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
1702 N KINGSHIGHWAY ST, CAPE GIRARDEAU, MO 63701-2122
(573) 339-2000
(573) 339-1876
Mailing address
1702 N KINGSHIGHWAY ST, CAPE GIRARDEAU, MO 63701-2122
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
R2J89
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2633471
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
08/22/2020
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