Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2007-03-26
- Last updated
- 2026-05-06
Licenses
- License MO
- 2006013605
Location
- Practice location
- 119 BAVARIAN HILLS PLZ
- City
- HERMANN MO
- Postal code
- 650411604
- Phone
- 573-486-2612
Organization contact
- Name
- MICHAEL MCINTOSH
- Title
- Manager
- Phone
- 3147066985
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.