Healthcare Provider Details

I. General information

NPI: 1679809123
Provider Name (Legal Business Name): AMEDISYS MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 10/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 PENNRIDGE DR SUITE 119
BRIDGETON MO
63044-1244
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-4900
  • Fax: 314-291-4910
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number786-2HH
License Number StateMO

VIII. Authorized Official

Name: WILLIAM F BORNE
Title or Position: CEO
Credential:
Phone: 225-292-2031