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Organization

MEDSOURCE OF ST. LOUIS, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARK COFFETT (PRESIDENT)
(314) 966-1818
Entity
Organization

Contact information

Practice address
3394 MCKELVEY RD., SUITE 102, SAINT LOUIS, MO 63044
(314) 966-1818
(314) 966-1001
Mailing address
3394 MCKELVEY RD., SUITE 102, SAINT LOUIS, MO 63044
(314) 966-1818
(314) 966-1001

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
15710874
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
29678
BLUE CROSS BLUE SHIELD
MO
05
626012405
MO
Enumeration date
07/26/2006
Last updated
12/18/2015
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