MEDICARE: ESB 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	332BX2000X	Oxygen Equipment & Supplies (DME)	2003022170	MO

General Provider Information

NPI Number	:	1568460368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESB MEDICAL LLC

Provider Business Mailing Address
First Line	:	6651 CHIPPEWA ST
Second Line	:	SUITE 219
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2538
Country	:	US
Telephone Number	:	314-646-0980
Fax Number	:	314-646-0613

Provider Business Practice Location Address
First Line	:	6651 CHIPPEWA ST
Second Line	:	SUITE 219
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2538
Country	:	US
Telephone Number	:	314-646-0980
Fax Number	:	314-646-0613

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDALL RATAY
Credential	:
Telephone Number	:	314-646-0980

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/22/2020

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