Healthcare Provider Details

I. General information

NPI: 1487915195
Provider Name (Legal Business Name): INSYNERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11477 OLDE CABIN RD STE 210
CREVE COEUR MO
63141-7129
US

IV. Provider business mailing address

11477 OLDE CABIN RD STE 210
CREVE COEUR MO
63141-7129
US

V. Phone/Fax

Practice location:
  • Phone: 314-649-7867
  • Fax:
Mailing address:
  • Phone: 314-649-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTURO TACA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 314-649-7867