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General NPI Number Information
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NPI Number | 1659774776
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Entity Type | Organization
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Legal Business Name | ELITE MENS HEALTH OF ST LOUIS
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 777 CRAIG RD 225
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7138
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Country | US
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Telephone | 870-761-5532
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 HIGHWAY 67 S SUITE E
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City | POCAHONTAS
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State | AR
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Zip | 72455-4001
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Country | US
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Telephone | 870-761-5532
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Fax | 870-892-3004
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT TAYLOR
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Credential |
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Telephone | 870-761-5532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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