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General NPI Number Information
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NPI Number | 1962564245
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Entity Type | Organization
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Legal Business Name | OUTSIDE THE BOX, INC.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1475 KISKER RD SUITE 270
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City | SAINT CHARLES
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State | MO
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Zip | 63304-8781
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Country | US
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Telephone | 636-926-2020
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Fax | 636-926-3926
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Provider Business Mailing Address
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Address Line | 1475 KISKER RD SUITE 270
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City | SAINT CHARLES
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State | MO
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Zip | 63304-8781
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Country | US
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Telephone | 636-926-2020
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Fax | 636-926-3926
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Authorized Official
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Title or Position | OWNER
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Name | LAURENCE A LEVINE
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Credential | MD
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Telephone | 636-926-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD R4836
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License Number State | MO
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