Provider Demographics
NPI:1962785295
Name:SPINNAKERS LLC
Entity type:Organization
Organization Name:SPINNAKERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-757-7244
Mailing Address - Street 1:16029 MEADOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7242
Mailing Address - Country:US
Mailing Address - Phone:314-757-7244
Mailing Address - Fax:757-215-0779
Practice Address - Street 1:15620 MANCHESTER RD
Practice Address - Street 2:SUITE 33
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2276
Practice Address - Country:US
Practice Address - Phone:314-757-7244
Practice Address - Fax:757-215-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 207R00000X, 208100000X
MO26D2031980291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty