MEDICARE: MENESY MEDICAL LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497185086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENESY MEDICAL LLC

Provider Business Mailing Address
First Line	:	1003 LEMAY FERRY RD UNIT B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1745
Country	:	US
Telephone Number	:	314-536-3754
Fax Number	:	314-329-3335

Provider Business Practice Location Address
First Line	:	1003 LEMAY FERRY RD UNIT B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1745
Country	:	US
Telephone Number	:	314-638-3333
Fax Number	:	314-329-3335

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	NEEKA N MENEH
Credential	:
Telephone Number	:	314-638-3333

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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