Organization
CRESCENT MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DAPHENE SMITH PA-C (PRESIDENT)
(314) 266-2107
Entity
Organization
Contact information
Practice address
6721 W FLORISSANT AVE, SAINT LOUIS, MO 63136-3634
(314) 266-2107
Mailing address
6721 W FLORISSANT AVE, SAINT LOUIS, MO 63136-3634
(314) 266-2107
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
085-001790
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216097002
—
IL
Enumeration date
04/26/2011
Last updated
04/26/2011
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