Provider Demographics
NPI:1346397585
Name:APOLLO MEDICAL, INC.
Entity Type:Organization
Organization Name:APOLLO MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-692-0611
Mailing Address - Street 1:8220 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2174
Mailing Address - Country:US
Mailing Address - Phone:314-692-0611
Mailing Address - Fax:314-237-0055
Practice Address - Street 1:8220 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2174
Practice Address - Country:US
Practice Address - Phone:314-692-0611
Practice Address - Fax:314-237-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO747-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267580Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER