Organization
PHOENIX HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE SCOTT HERMAN (PRESIDENT & SECRETARY)
(903) 390-4040
Entity
Organization
Contact information
Practice address
1839 E INDEPENDENCE ST STE K, SPRINGFIELD, MO 65804-3753
(417) 881-7442
Mailing address
3450 N. ROCK RD., #213, ATTN: DEBRA MULLEN, WITCHITA, KS 67226-1352
(316) 688-5511
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA7399
MEDICARE
MO
Enumeration date
02/02/2021
Last updated
12/10/2021
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