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General NPI Number Information
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NPI Number | 1245639673
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Entity Type | Organization
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Legal Business Name | MISSOURI HEALTHCARE LLC
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 2901 UNION RD UNIT 205B
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3972
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Country | US
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Telephone | 314-925-7517
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Fax | 314-925-7511
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Provider Business Mailing Address
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Address Line | 2901 UNION RD UNIT 205B
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City | SAINT LOUIS
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State | MO
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Zip | 63125-3972
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Country | US
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Telephone | 314-925-7517
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Fax | 314-925-7511
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Authorized Official
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Title or Position | OWNER
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Name | RUSLAN NURUSHEV
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Credential |
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Telephone | 314-925-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 105827
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License Number State | MO
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