Healthcare Provider Details

I. General information

NPI: 1518323062
Provider Name (Legal Business Name): W2W 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD SUITE 220
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

PO BOX 468029
ATLANTA GA
31146-8029
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-3336
  • Fax: 314-644-5606
Mailing address:
  • Phone: 404-943-0205
  • Fax: 404-943-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. SHELLEY DEPP
Title or Position: PAYER RELATIONS LIAISON
Credential:
Phone: 770-579-2626