Healthcare Provider Details

I. General information

NPI: 1861906703
Provider Name (Legal Business Name): HARNESS PODIATRY HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 1ST CAPITOL DR STE 340
SAINT CHARLES MO
63301-2852
US

IV. Provider business mailing address

1035 BELLEVUE AVE STE 315
SAINT LOUIS MO
63117-1856
US

V. Phone/Fax

Practice location:
  • Phone: 636-600-8011
  • Fax: 636-395-4043
Mailing address:
  • Phone: 314-473-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2004024287
License Number StateMO

VIII. Authorized Official

Name: JOHN D HARNESS
Title or Position: OWNER
Credential: DPM
Phone: 636-600-8011