Provider Demographics
NPI:1831887066
Name:PATRICIA REALTY
Entity type:Organization
Organization Name:PATRICIA REALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-604-2154
Mailing Address - Street 1:9916 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1989
Mailing Address - Country:US
Mailing Address - Phone:314-961-1642
Mailing Address - Fax:
Practice Address - Street 1:9916 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1989
Practice Address - Country:US
Practice Address - Phone:314-961-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURIES SHOES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization