Provider Demographics
NPI:1689703290
Name:LRVS MEDICAL LLC
Entity Type:Organization
Organization Name:LRVS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-504-6032
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-504-6032
Mailing Address - Fax:314-831-0988
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 2003
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-504-6032
Practice Address - Fax:314-831-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty