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General NPI Number Information
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NPI Number | 1144798737
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Entity Type | Organization
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Legal Business Name | FRG RLT HOLDINGS, INC.
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 1747 SMIZER STATION RD STE 1
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City | FENTON
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State | MO
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Zip | 63026-2784
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Country | US
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Telephone | 636-861-2125
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Fax | 636-861-1691
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Provider Business Mailing Address
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Address Line | PO BOX 790379
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City | SAINT LOUIS
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State | MO
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Zip | 63179-0379
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Country | US
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Telephone | 314-628-1405
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Fax | 314-878-4562
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | AMY L ELLIOTT
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Credential |
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Telephone | 314-593-2694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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