Healthcare Provider Details

I. General information

NPI: 1982140927
Provider Name (Legal Business Name): AMELIA MEIGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 W PINE BLVD APT 10A
SAINT LOUIS MO
63108-1475
US

IV. Provider business mailing address

4949 W PINE BLVD APT 10A
SAINT LOUIS MO
63108-1475
US

V. Phone/Fax

Practice location:
  • Phone: 425-591-8004
  • Fax:
Mailing address:
  • Phone: 425-591-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: