Provider Demographics
NPI:1437707551
Name:HOME DOCS MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:HOME DOCS MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JULLIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-376-4045
Mailing Address - Street 1:7584 OLIVE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1600
Mailing Address - Country:US
Mailing Address - Phone:314-376-4045
Mailing Address - Fax:314-376-4046
Practice Address - Street 1:7584 OLIVE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-1600
Practice Address - Country:US
Practice Address - Phone:314-376-4045
Practice Address - Fax:314-376-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty