Provider Demographics
NPI:1972594430
Name:MEDI-PLEX HEALTHCARE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:MEDI-PLEX HEALTHCARE PROFESSIONALS, LLC
Other - Org Name:MEDI-PLEX HEALTH PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITE-KINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN
Authorized Official - Phone:314-993-5580
Mailing Address - Street 1:1470 S VANDEVENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2336
Mailing Address - Country:US
Mailing Address - Phone:314-993-5580
Mailing Address - Fax:314-991-7745
Practice Address - Street 1:1470 S VANDEVENTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2336
Practice Address - Country:US
Practice Address - Phone:314-993-5580
Practice Address - Fax:314-991-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO727-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO585874506Medicaid