NPI 1053859397

Provident Place Consumer Directed Services

Organisation Health Maintenance Organization Saint Louis, MO

Practice location

Address: 1515 N Warson Rd Suite 241, Saint Louis, MO 63132-1111
Phone: (314) 922-9841

Authorised official

Name: Aigner R Smith
Title: Owner
Phone: (314) 922-9841

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X

Other Health Maintenance Organization providers in Missouri →

Registry record

NPI: 1053859397
Entity type: Organization
NPI issued: 7 Feb 2017
Record last updated: 7 Feb 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.