Healthcare Provider Details

I. General information

NPI: 1710821558
Provider Name (Legal Business Name): MISSOURI IV THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W PORT PLZ STE 650
SAINT LOUIS MO
63146-3011
US

IV. Provider business mailing address

111 W PORT PLZ STE 650
SAINT LOUIS MO
63146-3011
US

V. Phone/Fax

Practice location:
  • Phone: 224-390-0191
  • Fax:
Mailing address:
  • Phone: 224-390-0191
  • 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: ELIYAHU YITZHAK CARUTHERS
Title or Position: DIRECTOR OF INVENTORY
Credential:
Phone: 224-390-0191