Healthcare Provider Details

I. General information

NPI: 1831259373
Provider Name (Legal Business Name): ADVANTAGE PULMONARY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N MASON RD SUITE 250
SAINT LOUIS MO
63141-6338
US

IV. Provider business mailing address

969 N MASON RD SUITE 250
SAINT LOUIS MO
63141-6338
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-4699
  • Fax: 314-878-3558
Mailing address:
  • Phone: 314-878-4699
  • Fax: 314-878-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL REAGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-878-4699