Healthcare Provider Details

I. General information

NPI: 1477126894
Provider Name (Legal Business Name): STEVEN SOMMERICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DERBY LN
SAINT PETERS MO
63376-1318
US

IV. Provider business mailing address

401 CORPORATE PARK DR
SAINT LOUIS MO
63105-4201
US

V. Phone/Fax

Practice location:
  • Phone: 314-413-1617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2015031126
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: