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General NPI Number Information
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NPI Number | 1437783776
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Entity Type | Organization
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Legal Business Name | MAGER & GOUGELMAN OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1880
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1218
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Country | US
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Telephone | 314-726-1818
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Fax | 314-726-0295
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD STE 1880
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1218
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Country | US
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Telephone | 314-726-1818
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Fax | 314-726-0295
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD MICHAEL CHILES
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Credential | BCO, BADO
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Telephone | 314-726-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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