Healthcare Provider Details

I. General information

NPI: 1366626202
Provider Name (Legal Business Name): STREAMLINE ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S VANDEVENTER AVE
SAINT LOUIS MO
63110-1239
US

IV. Provider business mailing address

615 S VANDEVENTER AVE
SAINT LOUIS MO
63110-1239
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-9100
  • Fax:
Mailing address:
  • Phone: 314-289-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY D VOGL
Title or Position: PRESIDENT
Credential: CO
Phone: 314-368-9438