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General NPI Number Information
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NPI Number | 1861105991
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Entity Type | Organization
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Legal Business Name | MONITORED LIFE LLC
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/07/2023
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Provider Practice Location Address
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Address Line | 6907 PAGE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63133-1507
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Country | US
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Telephone | 636-800-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 6907 PAGE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63133-1507
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Country | US
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Telephone | 636-800-2401
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/LAB TECH
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Name | MS. BIANCA GIST
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Credential |
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Telephone | 636-800-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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