MEDICARE: CARESTL HEALTH #2

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	335E00000X	Prosthetic/Orthotic Supplier
5	3336C0002X	Clinic Pharmacy	2005035950	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2049138	OTHER		PK

General Provider Information

NPI Number	:	1467494062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESTL HEALTH #2

Provider Business Mailing Address
First Line	:	5541 RIVERVIEW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2443
Country	:	US
Telephone Number	:	314-389-4566
Fax Number	:	314-389-5514

Provider Business Practice Location Address
First Line	:	5541 RIVERVIEW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120
Country	:	US
Telephone Number	:	314-389-4566
Fax Number	:	314-382-0263

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. ANGELA RENEE CLABON
Credential	:
Telephone Number	:	314-367-5820

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	09/14/2020

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Directions to “CARESTL HEALTH #2 ” Practice Location

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