Healthcare Provider Details

I. General information

NPI: 1295909570
Provider Name (Legal Business Name): XEREX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY STE C
HIGHLAND IL
62249-1960
US

IV. Provider business mailing address

PO BOX 956397
SAINT LOUIS MO
63195-6397
US

V. Phone/Fax

Practice location:
  • Phone: 618-654-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: KEITH THOMAE
Title or Position: MD
Credential: MD
Phone: 618-654-8100