MEDICARE: PERFECT CARE HEALTH SERVICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	2426	MO

General Provider Information

NPI Number	:	1194257600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFECT CARE HEALTH SERVICE LLC

Provider Business Mailing Address
First Line	:	1033 CORPORATE SQUARE DR STE 110
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	800-933-8644
Fax Number	:	314-699-4064

Provider Business Practice Location Address
First Line	:	1033 CORPORATE SQUARE DR STE 110
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	800-933-8644
Fax Number	:	314-699-4064

Authorized Official
Title or Position	:	MANAGER
Name	:	DOROTHY COOPWOOD
Credential	:
Telephone Number	:	314-420-4360

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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