Healthcare Provider Details

I. General information

NPI: 1104600451
Provider Name (Legal Business Name): PA STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14561 N OUTER 40 RD
CHESTERFIELD MO
63017-5703
US

IV. Provider business mailing address

58 VERDANT VIEW MANOR CT
WENTZVILLE MO
63385-4995
US

V. Phone/Fax

Practice location:
  • Phone: 314-881-4280
  • Fax: 314-881-4296
Mailing address:
  • Phone: 314-608-9438
  • Fax: 636-674-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GRASSINO
Title or Position: OWNER
Credential: DMS
Phone: 314-608-9438