Healthcare Provider Details

I. General information

NPI: 1013479716
Provider Name (Legal Business Name): MH HEALTH CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 HAMPTON AVENUE
ST. LOUIS MO
63139
US

IV. Provider business mailing address

1403 HAMPTON AVE
SAINT LOUIS MO
63139-3115
US

V. Phone/Fax

Practice location:
  • Phone: 314-955-9355
  • Fax:
Mailing address:
  • Phone: 314-955-2179
  • Fax: 314-955-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES VAN EVERY
Title or Position: MANAGER CENTRAL SUPPORT
Credential:
Phone: 408-406-9646