Provider Demographics
NPI:1568460368
Name:ESB MEDICAL LLC
Entity Type:Organization
Organization Name:ESB MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:RATAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-646-0980
Mailing Address - Street 1:6651 CHIPPEWA ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2538
Mailing Address - Country:US
Mailing Address - Phone:314-646-0980
Mailing Address - Fax:314-646-0613
Practice Address - Street 1:6651 CHIPPEWA ST
Practice Address - Street 2:SUITE 219
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2538
Practice Address - Country:US
Practice Address - Phone:314-646-0980
Practice Address - Fax:314-646-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022170332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies