Provider Demographics
NPI:1073374617
Name:FLIGHT REPUBLIC PROPERTY ORGANIZATION
Entity type:Organization
Organization Name:FLIGHT REPUBLIC PROPERTY ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDBEYKWAHMAROK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-206-6154
Mailing Address - Street 1:3430 MCKELVEY RD STE L
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2556
Mailing Address - Country:US
Mailing Address - Phone:636-206-6154
Mailing Address - Fax:279-203-0587
Practice Address - Street 1:3430 MCKELVEY RD STE L
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2556
Practice Address - Country:US
Practice Address - Phone:636-206-6154
Practice Address - Fax:279-203-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies