MEDICARE: SAMUELA KOYFMAN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker
4	372500000X	Chore Provider

General Provider Information

NPI Number	:	1154723179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUELA KOYFMAN

Provider Business Mailing Address
First Line	:	1173 N PRICE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2301
Country	:	US
Telephone Number	:	314-569-1899
Fax Number	:	314-569-9026

Provider Business Practice Location Address
First Line	:	1173 N PRICE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2301
Country	:	US
Telephone Number	:	314-569-1899
Fax Number	:	314-569-9026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	10/25/2018

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Directions to “ SAMUELA KOYFMAN ” Practice Location

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