MEDICARE: AFFINIA HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	500899596	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	26D0983729	OTHER		CLIA

General Provider Information

NPI Number	:	1013925890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINIA HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 551
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63188-0551
Country	:	US
Telephone Number	:	314-898-1700
Fax Number	:	314-814-8542

Provider Business Practice Location Address
First Line	:	3930 S BROADWAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4626
Country	:	US
Telephone Number	:	314-577-6232
Fax Number	:	314-814-8542

Authorized Official
Title or Position	:	CFO
Name	:	MRS. JANET VOSS
Credential	:
Telephone Number	:	314-814-8571

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	09/27/2021

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Directions to “AFFINIA HEALTHCARE ” Practice Location

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