1649482811 NPI number — CENTER FOR INTEGRATED HEALTH LLC

Table of content: KAREN D. WILLIS BS, PTA (NPI 1750503413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649482811 NPI number — CENTER FOR INTEGRATED HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR INTEGRATED HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649482811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 CLAYTON RD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-781-8887
Provider Business Mailing Address Fax Number:
314-863-8115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 CLAYTON RD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-781-8887
Provider Business Practice Location Address Fax Number:
314-863-8115
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FINK
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-781-8887

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CE006544 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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