MEDICARE: QUAL-T-MED, INC

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	207RI0200X	Infectious Disease Physician	25858	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290006733	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	07310	OTHER		GENCARE
3	1017503	OTHER	MO	CARE PARTNERS
4	17745	OTHER		ANTHEM
5	100134	OTHER		HEALTHLINK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	92000	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1174742753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAL-T-MED, INC

Provider Business Mailing Address
First Line	:	43 QUAIL WOODS DR
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-3444
Country	:	US
Telephone Number	:	314-422-7791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3038
Country	:	US
Telephone Number	:	314-422-7791
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAY WILLIAM BURMEISTER
Credential	:	M.D
Telephone Number	:	314-849-6611

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2011

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Directions to “QUAL-T-MED, INC ” Practice Location

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