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General NPI Number Information
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NPI Number | 1447669767
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Entity Type | Organization
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Legal Business Name | PERSONAL CARE MEDICAL ENTERPRISE
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 5933 S HIGHWAY 94 SUITE 102
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City | WELDON SPRING
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State | MO
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Zip | 63304-5610
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Country | US
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Telephone | 636-477-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 5933 S HIGHWAY 94 SUITE 102
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City | WELDON SPRING
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State | MO
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Zip | 63304-5610
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Country | US
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Telephone | 636-477-6085
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. NICOLAS WIEGAND
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Credential |
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Telephone | 636-477-6085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LC1363451
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License Number State | MO
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