Organization
SKIWISE LLC
Active
Other names
SkiWise Health and Wellness Services
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ALICIA D BUCK (DIRECTOR)
(341) 475-8532
Entity
Organization
Contact information
Practice address
449 N EUCLID AVE, SAINT LOUIS, MO 63108-1642
(314) 475-8532
Mailing address
449 N EUCLID AVE, SAINT LOUIS, MO 63108-1642
(314) 475-8532
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490051600
—
MO
05
—
500099408
—
MO
Enumeration date
04/06/2017
Last updated
11/23/2021
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