Provider Demographics
NPI:1255873253
Name:EMPOWER HEALTH LLC
Entity type:Organization
Organization Name:EMPOWER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-778-3222
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:STE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-778-3222
Mailing Address - Fax:314-787-4894
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:STE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-778-3222
Practice Address - Fax:314-787-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty