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General NPI Number Information
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NPI Number | 1437707551
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Entity Type | Organization
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Legal Business Name | HOME DOCS MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/02/2019
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Last Update Date | 09/02/2019
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Provider Practice Location Address
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Address Line | 7584 OLIVE BLVD STE 204
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-1600
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Country | US
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Telephone | 314-376-4045
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Fax | 314-376-4046
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Provider Business Mailing Address
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Address Line | 7584 OLIVE BLVD STE 204
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-1600
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Country | US
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Telephone | 314-376-4045
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Fax | 314-376-4046
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Authorized Official
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Title or Position | VP, OPERATIONS
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Name | JULLIETTE MARTIN
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Credential |
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Telephone | 314-376-4045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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