Provider Demographics
NPI:1851868236
Name:DR LAURIE MECHAM PC
Entity Type:Organization
Organization Name:DR LAURIE MECHAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:MECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:314-288-9525
Mailing Address - Street 1:1470 SAINT PAUL RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8210
Mailing Address - Country:US
Mailing Address - Phone:314-288-9525
Mailing Address - Fax:
Practice Address - Street 1:15480 CLAYTON RD STE 103
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3172
Practice Address - Country:US
Practice Address - Phone:314-288-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty