Healthcare Provider Details

I. General information

NPI: 1679670376
Provider Name (Legal Business Name): MAGELLAN HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 MAGELLAN PLZ
MARYLAND HEIGHTS MO
63043-4644
US

IV. Provider business mailing address

1115 OAKLEY LN
LAKE ST LOUIS MO
63367-1957
US

V. Phone/Fax

Practice location:
  • Phone: 314-387-4000
  • Fax:
Mailing address:
  • Phone: 636-332-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2000149482
License Number StateMO

VIII. Authorized Official

Name: MRS. TONI D MCCLURE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 314-387-4664