Slack, Kenneth Dale
Slack, Kenneth Dale is an individual health care provider with primary practice located at 211 Saint Francis Dr , Cape Girardeau MO 63703-5049. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Slack, Kenneth Dale can be contacted via phone (573) 339-1166.Contact Information
Primary practice address
211 Saint Francis Dr
Cape Girardeau MO 63703-5049
Phone: (573) 339-1166
Fax: (573) 339-7166
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 2017031964 | Missouri |
| Other Service Providers / Specialist | 174400000X | MD2003-0686 | New Mexico |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 44508 | Colorado |
Profile Details
| NPI number | 1548375637 |
|---|---|
| LBN Legal business name | Slack, Kenneth Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Feb 26th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548375637 | NPPES |
| New Mexico | MEDICAID | 41035259 | |
| New Mexico | MEDICAID | 86081039 |
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