Provider Demographics
NPI:1114452877
Name:MANDALA MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MANDALA MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-845-9010
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:STE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-845-9010
Mailing Address - Fax:314-845-6399
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:STE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3854
Practice Address - Country:US
Practice Address - Phone:314-845-9010
Practice Address - Fax:314-845-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty