Provider Demographics
NPI:1659774776
Name:ELITE MENS HEALTH OF ST LOUIS
Entity Type:Organization
Organization Name:ELITE MENS HEALTH OF ST LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-761-5532
Mailing Address - Street 1:1512 HIGHWAY 67 S
Mailing Address - Street 2:SUITE E
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4001
Mailing Address - Country:US
Mailing Address - Phone:870-761-5532
Mailing Address - Fax:870-892-3004
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:225
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7138
Practice Address - Country:US
Practice Address - Phone:870-761-5532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty