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General NPI Number Information
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NPI Number | 1518418516
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Entity Type | Organization
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Legal Business Name | AHCMO 1 LLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1585 WOODLAKE DR 104
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5740
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Country | US
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Telephone | 707-330-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 1585 WOODLAKE DR 104
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5740
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Country | US
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Telephone | 707-307-3401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK POUND
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Credential |
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Telephone | 707-307-3401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | MO
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