Healthcare Provider Details

I. General information

NPI: 1417252602
Provider Name (Legal Business Name): MEDCURO MANUFACTURING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9959 LIN FERRY DR
SAINT LOUIS MO
63123-6913
US

IV. Provider business mailing address

9959 LIN FERRY DR
SAINT LOUIS MO
63123-6913
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-5569
  • Fax: 314-842-0209
Mailing address:
  • Phone: 314-842-5569
  • Fax: 314-842-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY J PAGANO
Title or Position: PARTNER
Credential:
Phone: 314-567-8595