Provider Demographics
NPI:1073699732
Name:PRIVATE NURSING SERVICE INC.
Entity Type:Organization
Organization Name:PRIVATE NURSING SERVICE INC.
Other - Org Name:INDEPENDENT NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-544-2020
Mailing Address - Street 1:9713 GRAVOIS RD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4346
Mailing Address - Country:US
Mailing Address - Phone:314-544-2020
Mailing Address - Fax:314-544-2645
Practice Address - Street 1:9713 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-4346
Practice Address - Country:US
Practice Address - Phone:314-544-2020
Practice Address - Fax:314-544-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251B00000X, 251E00000X, 251X00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261896500Medicaid