Healthcare Provider Details

I. General information

NPI: 1467038562
Provider Name (Legal Business Name): OBAX INFRASTRUCTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 S MASON RD
SAINT LOUIS MO
63131-1634
US

IV. Provider business mailing address

2170 S MASON RD
SAINT LOUIS MO
63131-1634
US

V. Phone/Fax

Practice location:
  • Phone: 314-462-0620
  • Fax: 314-462-0621
Mailing address:
  • Phone: 314-462-0620
  • Fax: 314-462-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA MAWUENYEGA
Title or Position: MANAGER
Credential:
Phone: 314-462-0620