Provider Demographics
NPI:1437783776
Name:MAGER & GOUGELMAN OF ST. LOUIS, LLC
Entity Type:Organization
Organization Name:MAGER & GOUGELMAN OF ST. LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHILES
Authorized Official - Suffix:
Authorized Official - Credentials:BCO, BADO
Authorized Official - Phone:314-726-1818
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 1880
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1218
Mailing Address - Country:US
Mailing Address - Phone:314-726-1818
Mailing Address - Fax:314-726-0295
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 1880
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1218
Practice Address - Country:US
Practice Address - Phone:314-726-1818
Practice Address - Fax:314-726-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier