Healthcare Provider Details

I. General information

NPI: 1801919899
Provider Name (Legal Business Name): W2WLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD SUITE 220
ST LOUIS MO
63124-2056
US

IV. Provider business mailing address

PO BOX 957294
ST LOUIS MO
63195-7294
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-3336
  • Fax: 314-644-5606
Mailing address:
  • Phone: 314-644-3336
  • Fax: 314-644-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHLEEN FARIS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 314-644-3336