Provider Demographics
NPI:1639364185
Name:RAMIC ST. LOUIS, LLC
Entity Type:Organization
Organization Name:RAMIC ST. LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPPAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-472-9101
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1779
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-573-4629
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-863-0084
Practice Address - Fax:314-863-0096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOAPPLYING FOR MEDICARMedicare UPIN