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General NPI Number Information
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NPI Number | 1174742753
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Entity Type | Organization
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Legal Business Name | QUAL-T-MED, INC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 1501 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-3038
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Country | US
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Telephone | 314-422-7791
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Fax |
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Provider Business Mailing Address
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Address Line | 43 QUAIL WOODS DR
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City | FENTON
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State | MO
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Zip | 63026-3444
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Country | US
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Telephone | 314-422-7791
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAY WILLIAM BURMEISTER
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Credential | M.D
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Telephone | 314-849-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 25858
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License Number State | MO
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