Provider Demographics
NPI:1982026019
Name:PRIMARY HEALTHCARE STL, LLC
Entity Type:Organization
Organization Name:PRIMARY HEALTHCARE STL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER; PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ARNEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-571-0272
Mailing Address - Street 1:4464 GREER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2621
Mailing Address - Country:US
Mailing Address - Phone:314-571-0272
Mailing Address - Fax:
Practice Address - Street 1:4464 GREER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2621
Practice Address - Country:US
Practice Address - Phone:314-571-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN 128513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty