MEDICARE: MR. HERSI HERSI

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1477901684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HERSI HERSI

Provider Business Mailing Address
First Line	:	3636 S GEYER RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1237
Country	:	US
Telephone Number	:	858-752-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 S GEYER RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1237
Country	:	US
Telephone Number	:	858-752-7052
Fax Number	:

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

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/27/2016

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Directions to “ MR. HERSI HERSI ” Practice Location

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