Healthcare Provider Details

I. General information

NPI: 1700040896
Provider Name (Legal Business Name): PEDS' NEEDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 DELMAR BLVD SUITE A
SAINT LOUIS MO
63103-1808
US

IV. Provider business mailing address

1624 DELMAR BLVD SUITE A
SAINT LOUIS MO
63103-1808
US

V. Phone/Fax

Practice location:
  • Phone: 314-621-5900
  • Fax: 314-621-5266
Mailing address:
  • Phone: 314-621-5900
  • Fax: 314-621-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberJ208327004
License Number StateMO

VIII. Authorized Official

Name: MR. ANTUAN L. HALL SR.
Title or Position: CFO/VP
Credential:
Phone: 314-621-5900