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General NPI Number Information
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NPI Number | 1114606381
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Entity Type | Organization
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Legal Business Name | TOTAL LOVE HEALTH CARE LLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 111 CHURCH ST STE 201
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City | FERGUSON
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State | MO
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Zip | 63135-2458
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Country | US
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Telephone | 314-229-0632
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Fax | 314-237-1502
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Provider Business Mailing Address
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Address Line | 111 CHURCH ST STE 201
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City | FERGUSON
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State | MO
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Zip | 63135-2458
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Country | US
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Telephone | 314-229-0632
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MR. ANTONI GREGORY
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Credential | RDMS
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Telephone | 314-229-0632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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