Healthcare Provider Details

I. General information

NPI: 1982740528
Provider Name (Legal Business Name): SIGNATURE HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD SUITE 120
SAINT LOUIS MO
63129-1576
US

IV. Provider business mailing address

4850 LEMAY FERRY RD SUITE 101
SAINT LOUIS MO
63129-1576
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-0439
  • Fax: 314-416-7184
Mailing address:
  • Phone: 314-416-0439
  • Fax: 314-487-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS ELIZABETH R EARNHART
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 314-416-0439