Healthcare Provider Details

I. General information

NPI: 1215606108
Provider Name (Legal Business Name): MOKAREZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 TANQUERAY LN APT E
SAINT LOUIS MO
63129-1369
US

IV. Provider business mailing address

4941 TANQUERAY LN APT E
SAINT LOUIS MO
63129-1369
US

V. Phone/Fax

Practice location:
  • Phone: 269-271-5965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TERHON WILLIAMS JR.
Title or Position: OWNER
Credential:
Phone: 269-271-5965