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General NPI Number Information
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NPI Number | 1609242767
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Entity Type | Organization
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Legal Business Name | EHMD 2, LLC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 222 S WOODS MILL RD SUITE 360N
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3625
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Country | US
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Telephone | 636-489-0179
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Fax | 314-205-6786
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Provider Business Mailing Address
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Address Line | PO BOX 468029
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City | ATLANTA
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State | GA
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Zip | 31146-8029
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Country | US
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Telephone | 404-214-0205
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Fax | 404-214-0209
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Authorized Official
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Title or Position | PAYER RELATIONS LIAISON
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Name | SHELLEY DEPP
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Credential |
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Telephone | 770-579-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | MO
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