Provider Demographics
NPI:1811773674
Name:VOYAGE03, LLC
Entity type:Organization
Organization Name:VOYAGE03, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-431-8600
Mailing Address - Street 1:472 HIGHWAY P
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1591
Mailing Address - Country:US
Mailing Address - Phone:636-431-8600
Mailing Address - Fax:636-215-8296
Practice Address - Street 1:472 HIGHWAY P
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1591
Practice Address - Country:US
Practice Address - Phone:636-431-8600
Practice Address - Fax:636-215-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental