MEDICARE: GUSHLEFF HEALTHCARE, INC.

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	207R00000X	Internal Medicine Physician	106207	MO

General Provider Information

NPI Number	:	1427094986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUSHLEFF HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1309 LAKE SAINT LOUIS BLVD
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1322
Country	:	US
Telephone Number	:	636-561-2211
Fax Number	:	636-561-2590

Provider Business Practice Location Address
First Line	:	1309 LAKE SAINT LOUIS BLVD
Second Line	:
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1322
Country	:	US
Telephone Number	:	636-561-2211
Fax Number	:	636-561-2590

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. PATRICIA A GUSHLEFF
Credential	:	RN
Telephone Number	:	636-561-2211

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/22/2020

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