Healthcare Provider Details

I. General information

NPI: 1265941611
Provider Name (Legal Business Name): PAXTECUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 DOUGHERTY FERRY RD STE 100
SAINT LOUIS MO
63122-3356
US

IV. Provider business mailing address

2325 DOUGHERTY FERRY RD STE 100
SAINT LOUIS MO
63122-3356
US

V. Phone/Fax

Practice location:
  • Phone: 314-909-1359
  • Fax: 314-909-1370
Mailing address:
  • Phone: 314-909-1359
  • Fax: 314-909-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH REID RITCHIE
Title or Position: OWNER
Credential: MD
Phone: 314-913-0625