Basic Information
| Provider Information | |||||||||
| NPI: | 1639442718 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MO HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PALISADES VIEW DR | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630253702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363334500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2331 HAMPTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631392908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363334500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 02/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | ADA | ||||||||
| AuthorizedOfficialFirstName: | SREENU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6363334500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.