Provider Demographics
NPI:1982854121
Name:NUTRA, LLC
Entity Type:Organization
Organization Name:NUTRA, LLC
Other - Org Name:NUTRITION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ST. ONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-482-0732
Mailing Address - Street 1:14805 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7881
Mailing Address - Country:US
Mailing Address - Phone:636-386-3333
Mailing Address - Fax:636-527-2570
Practice Address - Street 1:14805 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7881
Practice Address - Country:US
Practice Address - Phone:636-386-3333
Practice Address - Fax:636-527-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17126991261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center