Provider Demographics
NPI:1194686600
Name:555 LLC
Entity type:Organization
Organization Name:555 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:SELYKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-886-0353
Mailing Address - Street 1:13535 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3004
Mailing Address - Country:US
Mailing Address - Phone:314-886-0353
Mailing Address - Fax:
Practice Address - Street 1:13535 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3004
Practice Address - Country:US
Practice Address - Phone:314-886-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)