Healthcare Provider Details

I. General information

NPI: 1811572068
Provider Name (Legal Business Name): HEALTH ALLY M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 BRIGHTON WAY
SAINT LOUIS MO
63105-1682
US

IV. Provider business mailing address

7750 MARYLAND AVE UNIT 11772
SAINT LOUIS MO
63105-5525
US

V. Phone/Fax

Practice location:
  • Phone: 888-236-1878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNIE NGUYEN
Title or Position: ORGANIZER
Credential: MD
Phone: 408-858-4687