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NPI Code Detail

MEDICARE: ADRAIN GILLISPIE

MEDICARE: ADRAIN GILLISPIE
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
1251E00000XHome Health Agency

Other Identifiers

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

General Provider Information

NPI Number : 1679899702
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRAIN GILLISPIE
Provider Business Mailing Address
First Line : 11140 OLD ST. CHARLES ROCK RD.
Second Line :
City : ST. LOUIS
State : MO
Zip : 63074
Country : US
Telephone Number : 314-429-6949
Fax Number :
Provider Business Practice Location Address
First Line : 11140 OLD SAINT CHARLES RD
Second Line :
City : SAINT ANN
State : MO
Zip : 63074-2113
Country : US
Telephone Number : 314-429-6949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2010
Last Update Date : 04/14/2010

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Directions to “ ADRAIN GILLISPIE ” Practice Location

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