Provider Demographics
NPI:1689898629
Name:MARK PETRE
Entity Type:Organization
Organization Name:MARK PETRE
Other - Org Name:PETRE CONSTRUCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PETRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-939-5919
Mailing Address - Street 1:1016 MOTHERHEAD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7664
Mailing Address - Country:US
Mailing Address - Phone:636-939-5919
Mailing Address - Fax:636-939-5919
Practice Address - Street 1:1016 MOTHERHEAD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7664
Practice Address - Country:US
Practice Address - Phone:636-939-5919
Practice Address - Fax:636-939-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies