| Affinia Healthcare | |
|
3930 S Broadway Saint Louis MO 63118-4626 | |
| (314) 577-6232 | |
| (314) 814-8542 |
| Full Name | Affinia Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 3930 S Broadway, Saint Louis, Missouri |
| Authorized Official Name and Position | Janet Voss (CFO) |
| Authorized Official Contact | 3148148571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affinia Healthcare Po Box 551 Saint Louis MO 63188-0551 Ph: (314) 898-1700 | Affinia Healthcare 3930 S Broadway Saint Louis MO 63118-4626 Ph: (314) 577-6232 |
| NPI Number | 1013925890 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 09/27/2021 |
| Medicare PECOS PAC ID | 1052386919 |
|---|---|
| Medicare Enrollment ID | O20051019000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013925890 | NPI | - | NPPES |
| 500899596 | Medicaid | MO | |
| 26D0983729 | Other | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 500899596 (Missouri) | Primary |
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