Healthcare Provider Details

I. General information

NPI: 1265371868
Provider Name (Legal Business Name): JEREMIAH BATES II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 SUNSET OFFICE DR STE 101
SAINT LOUIS MO
63127-1045
US

IV. Provider business mailing address

8300 JEFFERSON ST NE STE B
ALBUQUERQUE NM
87113-1734
US

V. Phone/Fax

Practice location:
  • Phone: 877-789-9659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: