Healthcare Provider Details

I. General information

NPI: 1447497763
Provider Name (Legal Business Name): SAINT-MARK ENTERPRISES 1855 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E OAK ST
FREDERIC WI
54837
US

IV. Provider business mailing address

PO BOX 98
EUREKA MO
63025-0098
US

V. Phone/Fax

Practice location:
  • Phone: 715-327-4208
  • Fax:
Mailing address:
  • Phone: 314-518-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK MILLER
Title or Position: OWNER
Credential:
Phone: 314-518-2427