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General NPI Number Information
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NPI Number | 1922167048
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Entity Type | Organization
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Legal Business Name | HEALTHMARK MEDICAL INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11600 MANCHESTER RD STE 101
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City | DES PERES
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State | MO
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Zip | 63131-4691
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Country | US
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Telephone | 314-822-8471
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Fax | 314-822-8476
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Provider Business Mailing Address
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Address Line | 11600 MANCHESTER RD STE 101
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City | DES PERES
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State | MO
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Zip | 63131-4691
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Country | US
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Telephone | 314-822-8471
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Fax | 314-822-8476
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUE EKSTROM
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Credential |
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Telephone | 314-822-8471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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