Healthcare Provider Details

I. General information

NPI: 1396454930
Provider Name (Legal Business Name): HEART2HEART PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N MAIN ST
O FALLON MO
63366-1743
US

IV. Provider business mailing address

706 N MAIN ST
O FALLON MO
63366-1743
US

V. Phone/Fax

Practice location:
  • Phone: 314-258-5941
  • Fax: 314-279-0255
Mailing address:
  • Phone: 314-258-5941
  • Fax: 314-279-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN BRUNO
Title or Position: OWNER
Credential: MD
Phone: 314-258-5941