Organization
PROVIDENT PLACE CONSUMER DIRECTED SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AIGNER R SMITH (OWNER)
(314) 922-9841
Entity
Organization
Contact information
Practice address
1515 N WARSON RD, SUITE 241, SAINT LOUIS, MO 63132-1111
(314) 922-9841
Mailing address
1515 N WARSON RD, SUITE 241, SAINT LOUIS, MO 63132-1111
(314) 922-9841
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
02/07/2017
Last updated
02/07/2017
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