MEDICARE: MISSOURIHEALTHPLUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	207V00000X	Obstetrics & Gynecology Physician
3	208000000X	Pediatrics Physician
4	363L00000X	Nurse Practitioner
5	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1174071328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURIHEALTHPLUS

Provider Business Mailing Address
First Line	:	7777 BONHOMME AVE
Second Line	:	SUITE 2300
City	:	CLAYTON
State	:	MO
Zip	:	63105-1911
Country	:	US
Telephone Number	:	314-786-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 BONHOMME AVE
Second Line	:	SUITE 2300
City	:	CLAYTON
State	:	MO
Zip	:	63105-1911
Country	:	US
Telephone Number	:	314-786-3330
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DANNY O'NEILL
Credential	:
Telephone Number	:	314-786-3330

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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Directions to “MISSOURIHEALTHPLUS ” Practice Location

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