Healthcare Provider Details

I. General information

NPI: 1639442718
Provider Name (Legal Business Name): MO HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 HAMPTON AVE
SAINT LOUIS MO
63139-2908
US

IV. Provider business mailing address

630 PALISADES VIEW DR
EUREKA MO
63025-3702
US

V. Phone/Fax

Practice location:
  • Phone: 636-333-4500
  • Fax:
Mailing address:
  • Phone: 636-333-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SREENU ADA
Title or Position: CO-OWNER
Credential: MD
Phone: 636-333-4500