Provider Demographics
NPI:1932513587
Name:MISSOURI HEALTHCARE
Entity Type:Organization
Organization Name:MISSOURI HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NURUSHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-533-5464
Mailing Address - Street 1:2901 UNION RD
Mailing Address - Street 2:STE 250 B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3972
Mailing Address - Country:US
Mailing Address - Phone:312-533-5464
Mailing Address - Fax:
Practice Address - Street 1:2901 UNION RD
Practice Address - Street 2:STE 250 B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3972
Practice Address - Country:US
Practice Address - Phone:312-533-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty