MEDICARE: LEAH POTTS

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1295596773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH POTTS

Provider Business Mailing Address
First Line	:	3110 MAGNOLIA AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1272
Country	:	US
Telephone Number	:	314-345-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 MAGNOLIA AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1272
Country	:	US
Telephone Number	:	314-345-0597
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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Directions to “ LEAH POTTS ” Practice Location

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