MEDICARE: VIP HEALTHCARE PROFESSIONALS, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124468434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP HEALTHCARE PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	1610 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3031
Country	:	US
Telephone Number	:	314-645-2273
Fax Number	:	314-645-2275

Provider Business Practice Location Address
First Line	:	1610 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3031
Country	:	US
Telephone Number	:	314-645-2273
Fax Number	:	314-645-2275

Authorized Official
Title or Position	:	PRESIDENT CEO OWNER
Name	:	MRS. VEEDA L DIGGS
Credential	:
Telephone Number	:	314-645-2273

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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