MEDICARE: RED EYE 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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1821493545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED EYE LLC

Provider Business Mailing Address
First Line	:	9717 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1503
Country	:	US
Telephone Number	:	314-997-0002
Fax Number	:	314-997-7723

Provider Business Practice Location Address
First Line	:	9717 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1503
Country	:	US
Telephone Number	:	314-997-0002
Fax Number	:	314-997-7723

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	TONY ERKER
Credential	:
Telephone Number	:	314-997-0002

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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Directions to “RED EYE LLC ” Practice Location

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