Healthcare Provider Details

I. General information

NPI: 1437227998
Provider Name (Legal Business Name): BI-STATE DEVELOPMENT AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N 1ST ST
SAINT LOUIS MO
63102-2552
US

IV. Provider business mailing address

707 N 1ST ST
SAINT LOUIS MO
63102-2552
US

V. Phone/Fax

Practice location:
  • Phone: 314-982-1505
  • Fax: 314-923-3038
Mailing address:
  • Phone: 314-982-1505
  • Fax: 314-923-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MS. JILL EVALYN HOLLAND
Title or Position: MANAGER OF TMA SERVICES
Credential:
Phone: 314-982-1505