Healthcare Provider Details

I. General information

NPI: 1477602100
Provider Name (Legal Business Name): PROFESSIONAL HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16341 CENTERPOINTE DR
GROVER MO
63040-1602
US

IV. Provider business mailing address

PO BOX 722
GROVER MO
63040-0722
US

V. Phone/Fax

Practice location:
  • Phone: 636-458-4405
  • Fax: 636-458-4409
Mailing address:
  • Phone: 636-458-4405
  • Fax: 636-458-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY PAUL SPERR
Title or Position: PRESIDENT
Credential:
Phone: 636-458-4405