MEDICARE: HOSPICE OF 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	251G00000X	Community Based Hospice Care Agency	1321HO	MO

General Provider Information

NPI Number	:	1477559326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF MISSOURI, INC.

Provider Business Mailing Address
First Line	:	2191 LEMAY FERRY RD
Second Line	:	SUITE 301
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-2408
Country	:	US
Telephone Number	:	314-815-3000
Fax Number	:	314-815-3207

Provider Business Practice Location Address
First Line	:	6420 S LINDBERGH BLVD
Second Line	:	STE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7806
Country	:	US
Telephone Number	:	314-892-3000
Fax Number	:	314-892-3101

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. DAWN E. MULLINS
Credential	:	R.N., B.S.N.
Telephone Number	:	314-815-3434

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/01/2008

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