Healthcare Provider Details

I. General information

NPI: 1124015763
Provider Name (Legal Business Name): OPTIMA HEARTCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13358 MANCHESTER RD SUITE 120
SAINT LOUIS MO
63131-1730
US

IV. Provider business mailing address

13358 MANCHESTER RD SUITE 120
SAINT LOUIS MO
63131-1730
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-3023
  • Fax: 314-965-1477
Mailing address:
  • Phone: 314-965-3023
  • Fax: 314-965-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN R. RAABE
Title or Position: OWNER
Credential: M.D.
Phone: 314-965-3023