MEDICARE: HMO MISSOURI, 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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1457754434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HMO MISSOURI, INC.

Provider Business Mailing Address
First Line	:	1831 CHESTNUT ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2225
Country	:	US
Telephone Number	:	314-923-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 CHESTNUT ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2225
Country	:	US
Telephone Number	:	314-923-4444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN MARTENET
Credential	:
Telephone Number	:	314-923-4474

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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