MEDICARE: ALTA PRIMIER HEALTH SERVICES INC314

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1487713871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA PRIMIER HEALTH SERVICES INC314

Provider Business Mailing Address
First Line	:	2415 N KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-1109
Country	:	US
Telephone Number	:	314-367-1083
Fax Number	:	314-361-4740

Provider Business Practice Location Address
First Line	:	2415 N KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-1109
Country	:	US
Telephone Number	:	314-367-1083
Fax Number	:	314-361-4740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALPHONSE LOUIS BEAUBOEUF
Credential	:	M.D
Telephone Number	:	314-367-1083

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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