Provider Demographics
NPI:1447619325
Name:STACEY'S HEART HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:STACEY'S HEART HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-899-9211
Mailing Address - Street 1:7584 OLIVE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1600
Mailing Address - Country:US
Mailing Address - Phone:314-899-9211
Mailing Address - Fax:314-480-7069
Practice Address - Street 1:7584 OLIVE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-1600
Practice Address - Country:US
Practice Address - Phone:314-899-9211
Practice Address - Fax:314-480-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156514261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service