Healthcare Provider Details

I. General information

NPI: 1295445955
Provider Name (Legal Business Name): PROFESSIONAL REVENUE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 DEVONSHIRE AVE APT 2E
SAINT LOUIS MO
63109-2402
US

IV. Provider business mailing address

PO BOX 300141
UNIVERSITY CITY MO
63130-0441
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-9420
  • Fax: 314-584-7035
Mailing address:
  • Phone: 314-449-9420
  • Fax: 314-584-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DEJA SCOTT
Title or Position: FOUNDER/CEO
Credential: HEALTHCARE ADMIN
Phone: 314-449-9420