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General NPI Number Information
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NPI Number | 1972594430
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Entity Type | Organization
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Legal Business Name | MEDI-PLEX HEALTHCARE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 1470 S VANDEVENTER AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2336
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Country | US
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Telephone | 314-993-5580
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Fax | 314-991-7745
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Provider Business Mailing Address
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Address Line | 1470 S VANDEVENTER AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2336
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Country | US
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Telephone | 314-993-5580
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Fax | 314-991-7745
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MRS. GLENDA F WHITE-KINDELL
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Credential | BSN,RN
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Telephone | 314-993-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 727-3
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License Number State | MO
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