Provider Demographics
NPI:1174145668
Name:ESSENTIAL BENEFIT OFFERINGS, LLC
Entity type:Organization
Organization Name:ESSENTIAL BENEFIT OFFERINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-803-2941
Mailing Address - Street 1:1417 N MOUNT AUBURN RD STE A2
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2171
Mailing Address - Country:US
Mailing Address - Phone:573-803-2941
Mailing Address - Fax:573-803-4112
Practice Address - Street 1:1417 N MOUNT AUBURN RD STE A2
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-803-2941
Practice Address - Fax:573-803-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care