MEDICARE: MISSOURI MSO 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1538041769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI MSO LLC

Provider Business Mailing Address
First Line	:	4770 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CHARBONIER RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5308
Country	:	US
Telephone Number	:	212-734-6621
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SAMUEL KOHN
Credential	:
Telephone Number	:	347-631-6775

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	01/08/2026

Similar Medicare Providers

1669569042 — TJW MANAGEMENT INC
Practice Location Address:

1501 CHARBONIER RD
FLORISSANT, MO
63031-5308

Practice Phone: 314-921-2700
Practice Fax: 314-921-8501

1265796387 — BENTWOOD HEALTHCARE LLC
Practice Location Address:

1501 CHARBONIER RD
FLORISSANT, MO
63031-5308

Practice Phone: 314-921-2700
Practice Fax:

1932719754 — RESTORATIVE SURGERY CENTER LLC
Practice Location Address:

6829 PARKER RD STE B
FLORISSANT, MO
63033-5308

Practice Phone: 314-741-2700
Practice Fax: 314-741-2701

1982553004 — BRANDON KYLE KILLIEBREW
Practice Location Address:

1152 SHACKELFORD RD
FLORISSANT, MO
63031-4369

Practice Phone: 314-388-1530
Practice Fax: 314-388-1550

1104784040 — CHARMING HEARTZ HOME CARE LLC
Practice Location Address:

185 ELDORADO DR
FLORISSANT, MO
63031-5318

Practice Phone: 314-374-2658
Practice Fax:

1215895677 — VIVA HEALTH SERVICES LLC
Practice Location Address:

2650 KNOLLWOOD LN
FLORISSANT, MO
63031-1702

Practice Phone: 314-357-1037
Practice Fax:

Directions to “MISSOURI MSO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.