Healthcare Provider Details

I. General information

NPI: 1457188641
Provider Name (Legal Business Name): EC MED SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 HACKMAN HOLLOW DR
WENTZVILLE MO
63385
US

IV. Provider business mailing address

1838 HACKMAN HOLLOW DR
WENTZVILLE MO
63385
US

V. Phone/Fax

Practice location:
  • Phone: 855-470-2492
  • Fax: 636-434-2500
Mailing address:
  • Phone: 855-470-2492
  • Fax: 636-434-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIERRA RAINEY
Title or Position: OWNER
Credential:
Phone: 312-340-4298