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General NPI Number Information
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NPI Number | 1952768509
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Entity Type | Organization
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Legal Business Name | DASH 360 DIAGNOSTICS
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2859 SIDNEY ST
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2332
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Country | US
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Telephone | 314-283-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 2859 SIDNEY ST
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City | SAINT LOUIS
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State | MO
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Zip | 63104-2332
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Country | US
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Telephone | 314-283-5245
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ALEXIS MORRIS
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Credential |
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Telephone | 314-283-5245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | U137117003
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License Number State | MO
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