| NPI | 1154755338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN GREER Manager 314-280-5557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 305R00000X) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MO 305R00000x) |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2017-01-18 |