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General NPI Number Information
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NPI Number | 1821493545
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Entity Type | Organization
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Legal Business Name | RED EYE LLC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 9717 CLAYTON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1503
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Country | US
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Telephone | 314-997-0002
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Fax | 314-997-7723
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Provider Business Mailing Address
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Address Line | 9717 CLAYTON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1503
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Country | US
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Telephone | 314-997-0002
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Fax | 314-997-7723
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | TONY ERKER
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Credential |
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Telephone | 314-997-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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