Healthcare Provider Details

I. General information

NPI: 1922167048
Provider Name (Legal Business Name): HEALTHMARK MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 MANCHESTER RD STE 101
DES PERES MO
63131-4691
US

IV. Provider business mailing address

11600 MANCHESTER RD STE 101
DES PERES MO
63131-4691
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-8471
  • Fax: 314-822-8476
Mailing address:
  • Phone: 314-822-8471
  • Fax: 314-822-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUE EKSTROM
Title or Position: PRESIDENT
Credential:
Phone: 314-822-8471