Organization
MBA CDS SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RHONDA L WILLIAMS MASTER'S OF ARTS (OWNER/CDS COORDINATOR)
(573) 380-0685
Entity
Organization
Contact information
Practice address
613 DAVIS BLVD, SIKESTON, MO 63801-1958
(573) 481-1088
(573) 355-5925
Mailing address
PO BOX 1386, SIKESTON, MO 63801-1386
(573) 481-1088
(573) 355-5925
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
6448
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23238011
EMPLOYEE IDENTIFICATION NUMBER
MO
Enumeration date
05/11/2017
Last updated
08/20/2021
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