Provider Demographics
NPI:1487838306
Name:BROWN'S ENTERPRISES
Entity Type:Organization
Organization Name:BROWN'S ENTERPRISES
Other - Org Name:NEW BALANCE-ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EILERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:314-646-1574
Mailing Address - Street 1:6678 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1602
Mailing Address - Country:US
Mailing Address - Phone:314-646-1574
Mailing Address - Fax:314-646-1578
Practice Address - Street 1:6678 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1602
Practice Address - Country:US
Practice Address - Phone:314-646-1574
Practice Address - Fax:314-646-1578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWN'S ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013370332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0510770002Medicare NSC