Provider Demographics
NPI:1447245378
Name:CORUM HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CORUM HEALTH SERVICES, INC.
Other - Org Name:CORUM HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-733-7300
Mailing Address - Street 1:14805 N OUTER 40 RD STE 140
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6060
Mailing Address - Country:US
Mailing Address - Phone:636-733-7300
Mailing Address - Fax:636-733-7334
Practice Address - Street 1:14805 N OUTER 40 RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6060
Practice Address - Country:US
Practice Address - Phone:636-733-7300
Practice Address - Fax:636-733-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0057113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO607781606Medicaid