Healthcare Provider Details

I. General information

NPI: 1114606381
Provider Name (Legal Business Name): TOTAL LOVE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHURCH ST STE 201
FERGUSON MO
63135-2458
US

IV. Provider business mailing address

111 CHURCH ST STE 201
FERGUSON MO
63135-2458
US

V. Phone/Fax

Practice location:
  • Phone: 314-229-0632
  • Fax: 314-237-1502
Mailing address:
  • Phone: 314-229-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONI GREGORY
Title or Position: OWNER OPERATOR
Credential: RDMS
Phone: 314-229-0632