Healthcare Provider Details

I. General information

NPI: 1861105991
Provider Name (Legal Business Name): MONITORED LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 PAGE AVE
SAINT LOUIS MO
63133-1507
US

IV. Provider business mailing address

6907 PAGE AVE
SAINT LOUIS MO
63133-1507
US

V. Phone/Fax

Practice location:
  • Phone: 636-800-2401
  • Fax:
Mailing address:
  • Phone: 636-800-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. BIANCA GIST
Title or Position: EXECUTIVE DIRECTOR/LAB TECH
Credential:
Phone: 636-800-2401