MEDICARE: ESSENCE HEALTHCARE, INC.

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	302R00000X	Health Maintenance Organization

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y0027	OTHER	MO	MULTI CONTRACT ENTITY

General Provider Information

NPI Number	:	1568740868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENCE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	13900 RIVERPORT DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4804
Country	:	US
Telephone Number	:	314-209-2700
Fax Number	:	314-209-3234

Provider Business Practice Location Address
First Line	:	13900 RIVERPORT DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4804
Country	:	US
Telephone Number	:	314-209-2700
Fax Number	:	314-209-3234

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MS. MARTHA BUTLER
Credential	:
Telephone Number	:	314-209-2700

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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