MEDICARE: MS. ARLINDA DAVIS CST, BA, (SHE/HER)

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	246ZS0410X	Surgical Technologist
2	372500000X	Chore Provider

General Provider Information

NPI Number	:	1730847104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARLINDA DAVIS CST, BA, (SHE/HER)

Provider Business Mailing Address
First Line	:	349 S CATHERWOOD AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-7338
Country	:	US
Telephone Number	:	463-212-2754
Fax Number	:

Provider Business Practice Location Address
First Line	:	4327 DARBY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-1417
Country	:	US
Telephone Number	:	463-212-2754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	12/02/2021

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