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General NPI Number Information
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NPI Number | 1265910442
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Entity Type | Organization
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Legal Business Name | EPIC HEALTHCARE AND WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 4919 JAMESTOWNE RIDGE CT
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City | BLACK JACK
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State | MO
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Zip | 63033-4554
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Country | US
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Telephone | 314-269-7868
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Fax | 310-929-2597
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Provider Business Mailing Address
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Address Line | 1551 WALL ST
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3539
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Country | US
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Telephone | 636-789-1499
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Fax | 310-929-2597
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE GRIMES
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Credential | FNP-BC
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Telephone | 636-789-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2017003919
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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