Broadway LTC, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PS2014040344 Issued in MO

Legal business name

BROADWAY LTC, LLC

Practice address

37 Doctors Park Ste 7
Cape Girardeau, MO 63703

Phone

(573) 803-2040

NPI assigned

Nov 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Wood

Title

Director of Pharmacy

Phone

(573) 576-3029

Specialties & licenses 1

Addresses

Other names 1

• Broadway Pharmacy LTC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1457758153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 BROADWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015514",
            "telephone_number": "573-335-8207",
            "fax_number": "573-335-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 DOCTORS PARK STE 7",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63703",
            "telephone_number": "573-803-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY LTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "573-576-3029"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "PS2014040344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broadway Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Long Term Care Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.