MEDICARE: HEALTHMARK MEDICAL 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1922167048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHMARK MEDICAL INC

Provider Business Mailing Address
First Line	:	11600 MANCHESTER RD
Second Line	:	STE 101
City	:	DES PERES
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-822-8471
Fax Number	:	314-822-8476

Provider Business Practice Location Address
First Line	:	11600 MANCHESTER RD
Second Line	:	STE 101
City	:	DES PERES
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-822-8471
Fax Number	:	314-822-8476

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SUE EKSTROM
Credential	:
Telephone Number	:	314-822-8471

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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Directions to “HEALTHMARK MEDICAL INC ” Practice Location

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