Organization
LIMITLESS EVOLUTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN DESKIN FEDERAL GOVERNMENT (OWNER)
(573) 693-9818
Entity
Organization
Contact information
Practice address
3524 OSAGE BEACH PKWY, OSAGE BEACH, MO 65065-5622
(573) 693-9818
Mailing address
3524 OSAGE BEACH PKWY, OSAGE BEACH, MO 65065-5622
(573) 693-9818
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
261Q00000X
Clinic/Center
—
—
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9HAHHA800
HIN
—
Enumeration date
10/06/2020
Last updated
10/06/2020
Update your record
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