Healthcare Provider Details

I. General information

NPI: 1730109588
Provider Name (Legal Business Name): NEXTRA HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12813 FLUSHING MEADOWS DR STE 100
SAINT LOUIS MO
63131-0015
US

IV. Provider business mailing address

12813 FLUSHING MEADOWS DR STE 100
SAINT LOUIS MO
63131-0015
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6020
  • Fax: 314-821-5102
Mailing address:
  • Phone: 800-950-6020
  • Fax: 314-821-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberB0028507A
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LC WADLE
Title or Position: COO
Credential:
Phone: 877-394-1860