Provider Demographics
NPI:1477602100
Name:PROFESSIONAL HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SPERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-458-4405
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-0722
Mailing Address - Country:US
Mailing Address - Phone:636-458-4405
Mailing Address - Fax:636-458-4409
Practice Address - Street 1:16341 CENTERPOINTE DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1602
Practice Address - Country:US
Practice Address - Phone:636-458-4405
Practice Address - Fax:636-458-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6304001Medicaid
IL=========6304001Medicaid
MO1314350001Medicare NSC
MO00095203Medicare ID - Type UnspecifiedLABORATORY