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Organization

KENNETH GERDES , LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JACKI JORDAN (BILLING MANAGER)
(314) 432-2580
Entity
Organization

Contact information

Practice address
11155 DUNN RD, SUITE 211N, SAINT LOUIS, MO 63136-6150
(314) 432-2580
(314) 991-8960
Mailing address
PO BOX 1209, MARYLAND HEIGHTS, MO 63043-0209
(314) 432-2580
(314) 991-8960

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
117124
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500745609
MO
01
DE2084
RR MCR GROUP PROV#
MO
Enumeration date
06/09/2006
Last updated
12/10/2024
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