Organization
MY BLOOMING HEALTH MOBILE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANITA SMITH RN (DIRECTOR)
(314) 942-3272
Entity
Organization
Contact information
Practice address
2040 WOODSON RD # 204A, SAINT LOUIS, MO 63114-5697
(314) 942-3273
(314) 584-2205
Mailing address
2040 WOODSON RD # 204A, SAINT LOUIS, MO 63114-5697
(314) 942-3273
(314) 584-2205
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
1309649
MO
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1080096
—
MO
Enumeration date
05/10/2013
Last updated
11/09/2021
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