Provider Demographics
NPI:1639442718
Name:MO HEALTH LLC
Entity Type:Organization
Organization Name:MO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENU
Authorized Official - Middle Name:
Authorized Official - Last Name:ADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-333-4500
Mailing Address - Street 1:630 PALISADES VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3702
Mailing Address - Country:US
Mailing Address - Phone:636-333-4500
Mailing Address - Fax:
Practice Address - Street 1:2331 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2908
Practice Address - Country:US
Practice Address - Phone:636-333-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty