MEDICARE: DASH 360 DIAGNOSTICS

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	251B00000X	Case Management Agency	U137117003	MO

General Provider Information

NPI Number	:	1952768509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DASH 360 DIAGNOSTICS

Provider Business Mailing Address
First Line	:	2859 SIDNEY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2332
Country	:	US
Telephone Number	:	314-283-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2859 SIDNEY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2332
Country	:	US
Telephone Number	:	314-283-5245
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ALEXIS MORRIS
Credential	:
Telephone Number	:	314-283-5245

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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