=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598185621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRESS FREE HEALTH TESTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2014
-----------------------------------------------------
Last Update Date | 04/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 LOCUST ST SUITE 403
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63103-1857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-978-3435
-----------------------------------------------------
Fax | 314-932-5291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 LOCUST ST SUITE 403
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63103-1857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-978-3435
-----------------------------------------------------
Fax | 314-932-5291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | AMIN MOHABBAT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-978-3435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246R00000X
-----------------------------------------------------
Taxonomy Name | Pathology Technician
-----------------------------------------------------
License Number | LC1064807
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------