Provider Demographics
NPI:1457655748
Name:MELRICH INC
Entity Type:Organization
Organization Name:MELRICH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3143-953-6356
Mailing Address - Street 1:625 CANNONBURY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5312
Mailing Address - Country:US
Mailing Address - Phone:314-395-3656
Mailing Address - Fax:
Practice Address - Street 1:625 CANNONBURY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5312
Practice Address - Country:US
Practice Address - Phone:314-395-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008006962207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3893809Medicaid
AL009976335Medicaid
MO207032707Medicaid
GA000834666MMedicaid
MO207032707Medicaid