MEDICARE: MILLENNIUM MANAGEMENT & CONSULTING, 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	314000000X	Skilled Nursing Facility	O31149	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912010109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM MANAGEMENT & CONSULTING, INC.

Provider Business Mailing Address
First Line	:	37 N CLARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63135-2323
Country	:	US
Telephone Number	:	314-521-7419
Fax Number	:	314-521-6889

Provider Business Practice Location Address
First Line	:	37 N CLARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63135-2323
Country	:	US
Telephone Number	:	314-521-7419
Fax Number	:	314-521-6889

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOHN BRENCICK
Credential	:
Telephone Number	:	314-374-7419

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	06/17/2009

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