Healthcare Provider Details

I. General information

NPI: 1518570696
Provider Name (Legal Business Name): HOME DRS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 DELMAR BLVD
UNIVERSITY CITY MO
63130-4341
US

IV. Provider business mailing address

7171 DELMAR BLVD
UNIVERSITY CITY MO
63130-4341
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-7764
  • Fax: 314-361-7776
Mailing address:
  • Phone: 314-361-7764
  • Fax: 314-361-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANETTE HAMILTON
Title or Position: CEO
Credential:
Phone: 314-361-7764