Provider Demographics
NPI:1467284638
Name:E MEDICAL GROUP OF MISSOURI NO 2 LLC
Entity type:Organization
Organization Name:E MEDICAL GROUP OF MISSOURI NO 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-539-2427
Mailing Address - Street 1:2301 HIGHWAY 1187 STE 203
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6139
Mailing Address - Country:US
Mailing Address - Phone:817-539-2427
Mailing Address - Fax:
Practice Address - Street 1:1053 CAVE SPRINGS RD STE 305
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6435
Practice Address - Country:US
Practice Address - Phone:660-263-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health