Healthcare Provider Details

I. General information

NPI: 1336470129
Provider Name (Legal Business Name): CRITICAL CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 EXECUTIVE PARKWAY DR SUITE 210
SAINT LOUIS MO
63141-6336
US

IV. Provider business mailing address

999 EXECUTIVE PARKWAY DR STE 210
SAINT LOUIS MO
63141-6336
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-6000
  • Fax:
Mailing address:
  • Phone: 314-514-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateWI

VIII. Authorized Official

Name: ISABELLE KOPEC
Title or Position: VP MEDICAL AFFAIRS
Credential: MD
Phone: 314-514-5000