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General NPI Number Information
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NPI Number | 1003246026
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Entity Type | Organization
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Legal Business Name | TRUE RESULTS MISSOURI, LLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 12855 N 40 DR SUITE 275
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 214-850-5377
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Fax |
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR SUITE 275
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEVEN EARL FANDRE
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Credential | PA-C
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Telephone | 214-389-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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