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NPI Code Detail

MEDICARE: IMAGINE ACADEMY OF ESM

MEDICARE: IMAGINE ACADEMY OF ESM
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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1548414790
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMAGINE ACADEMY OF ESM
Provider Business Mailing Address
First Line : 1008 S SPRING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2520
Country : US
Telephone Number : 314-773-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1008 S SPRING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2520
Country : US
Telephone Number : 314-773-4400
Fax Number :
Authorized Official
Title or Position : PRINCIPLE K-5
Name : ANGELE THIBODEAUX-BURNS
Credential :
Telephone Number : 314-773-4400
Provider Enumeration Date : 11/13/2008
Last Update Date : 11/13/2008

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Directions to “IMAGINE ACADEMY OF ESM ” Practice Location

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