Provider Demographics
NPI:1639645070
Name:BLUETAIL BIOLOGICS LLC
Entity Type:Organization
Organization Name:BLUETAIL BIOLOGICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-778-2826
Mailing Address - Street 1:17300 N OUTER 40 RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-778-2900
Mailing Address - Fax:636-778-2828
Practice Address - Street 1:17300 N OUTER 40 RD STE 201
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-778-2900
Practice Address - Fax:636-778-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty