Healthcare Provider Details

I. General information

NPI: 1740481258
Provider Name (Legal Business Name): LONG TERM CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEADOW ACRES
SAINT LOUIS MO
63124-1460
US

IV. Provider business mailing address

PO BOX 31637
SAINT LOUIS MO
63131-0637
US

V. Phone/Fax

Practice location:
  • Phone: 314-308-6965
  • Fax: 314-801-8700
Mailing address:
  • Phone: 314-308-6965
  • Fax: 314-801-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number102417
License Number StateMO

VIII. Authorized Official

Name: POONAM JAIN
Title or Position: OWNER
Credential: MD
Phone: 314-308-6965