Provider Demographics
NPI:1467038562
Name:OBAX INFRASTRUCTURES LLC
Entity Type:Organization
Organization Name:OBAX INFRASTRUCTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWUENYEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-462-0620
Mailing Address - Street 1:2170 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1634
Mailing Address - Country:US
Mailing Address - Phone:314-462-0620
Mailing Address - Fax:314-462-0621
Practice Address - Street 1:2170 S MASON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1634
Practice Address - Country:US
Practice Address - Phone:314-462-0620
Practice Address - Fax:314-462-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare