Healthcare Provider Details

I. General information

NPI: 1679175988
Provider Name (Legal Business Name): SIMPLY HEALTH INTEGRATED MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12977 N 40 DR STE 105
SAINT LOUIS MO
63141-8654
US

IV. Provider business mailing address

126 HILLTOWN VILLAGE CTR
CHESTERFIELD MO
63017-0709
US

V. Phone/Fax

Practice location:
  • Phone: 630-590-4686
  • Fax: 636-206-8361
Mailing address:
  • Phone: 630-590-4686
  • Fax: 888-859-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRYAN DELONEY
Title or Position: OWNER
Credential:
Phone: 636-590-4686