Healthcare Provider Details

I. General information

NPI: 1871535419
Provider Name (Legal Business Name): HOUSE CALL DOCTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 NETHERTON DR
SAINT LOUIS MO
63136-4674
US

IV. Provider business mailing address

2865 NETHERTON DR
SAINT LOUIS MO
63136-4674
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-0918
  • Fax:
Mailing address:
  • Phone: 314-653-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY PEVNICK
Title or Position: CO-OWNER
Credential: DPT
Phone: 314-653-0918