| Affinia Healthcare | |
|
1430 Olive St Suite 500 Saint Louis MO 63103-2303 | |
| (314) 206-3700 | |
| (314) 206-3708 |
| Full Name | Affinia Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 1430 Olive St, Saint Louis, Missouri |
| Authorized Official Name and Position | Alan O Freeman (CEO) |
| Authorized Official Contact | 3148148511 |
| 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 1430 Olive St Suite 500 Saint Louis MO 63103-2303 Ph: (314) 206-3700 |
| NPI Number | 1427221027 |
|---|---|
| Provider Enumeration Date | 04/04/2008 |
| Last Update Date | 04/08/2016 |
| Medicare PECOS PAC ID | 1052386919 |
|---|---|
| Medicare Enrollment ID | O20090217000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427221027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1427221027 (Missouri) | Primary |
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