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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up