| Elite Psychiatric Services, Llc | |
|
11133 Dunn Rd Saint Louis MO 63136-6119 | |
| (314) 653-5370 | |
| (314) 653-5399 |
| Full Name | Elite Psychiatric Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 11133 Dunn Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Shannon Michelle Jennings (PHYSICIAN) |
| Authorized Official Contact | 6364840632 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Psychiatric Services, Llc 1836 Lackland Hill Pkwy Saint Louis MO 63146-3572 Ph: (314) 872-1439 | Elite Psychiatric Services, Llc 11133 Dunn Rd Saint Louis MO 63136-6119 Ph: (314) 653-5370 |
| NPI Number | 1144428137 |
|---|---|
| Provider Enumeration Date | 07/11/2007 |
| Last Update Date | 09/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144428137 | NPI | - | NPPES |
| 504045402 | Medicaid | MO | |
| DF9548 | Other | MO | RR MEDICARE GROUP# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2004001640 (Missouri) | Primary |
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