Provider Demographics
NPI:1992055099
Name:DOMUS MEDICAL HOUSE CALLS, LLC
Entity type:Organization
Organization Name:DOMUS MEDICAL HOUSE CALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:314-910-1372
Mailing Address - Street 1:13380 AMIOT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2239
Mailing Address - Country:US
Mailing Address - Phone:314-910-1372
Mailing Address - Fax:314-542-0894
Practice Address - Street 1:13380 AMIOT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-2239
Practice Address - Country:US
Practice Address - Phone:314-910-1372
Practice Address - Fax:314-542-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty