Organization
MELRICH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD JAMES STORK MD (PRESIDENT, CEO)
31439536356
Entity
Organization
Contact information
Practice address
625 CANNONBURY DR, SAINT LOUIS, MO 63119-5312
(314) 395-3656
Mailing address
625 CANNONBURY DR, SAINT LOUIS, MO 63119-5312
(314) 395-3656
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2008006962
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000834666M
—
GA
05
—
009976335
—
AL
05
—
207032707
—
MO
05
—
3893809
—
TN
Enumeration date
12/31/2010
Last updated
12/31/2010
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