NPIMap

Organization Active NPI

New Balance Lake St. Louis

  • Durable Medical Equipment & Medical Supplies
  • Lake St Louis, MO
National Provider Identifier
1114165263
Registry record updated Jan 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
013370 Issued in MO
Legal business name
NEW BALANCE LAKE ST. LOUIS
Practice address
21 Meadows Circle Dr
Suite 314
Lake St Louis, MO 63367-4109
Phone
(636) 561-2204
Fax
(636) 625-2611
NPI assigned
Jan 28, 2009
Organization subpart
Yes
Parent organization
BROWN'S ENTERPRISESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Chad Louis Brown, C.PED
Title
Certified Pedorthist
Phone
(636) 561-2204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 013370 MO Primary

Addresses

Primary practice location

21 Meadows Circle Dr
Suite 314
Lake St Louis, MO 63367-4109

Mailing address

21 Meadows Circle Dr
Suite 314
Lake St Louis, MO 63367-4109
Phone (636) 561-2204

National Provider Directory

National Provider Directory
Tax ID family
Brown'S Enterprises5 organizations share this tax ID, including this one
Part of
Brown'S Enterprises

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

21 Meadows Circle Dr
Ste 314
Lake St Louis, MO 63367
Phone (636) 561-2204

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233100800000",
    "number": "1114165263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 MEADOWS CIRCLE DR",
            "address_2": "SUITE 314",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633674109",
            "telephone_number": "636-561-2204",
            "fax_number": "636-625-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MEADOWS CIRCLE DR",
            "address_2": "SUITE 314",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633674109",
            "telephone_number": "636-561-2204",
            "fax_number": "636-625-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW BALANCE LAKE ST. LOUIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROWN'S ENTERPRISES",
        "enumeration_date": "2009-01-28",
        "last_updated": "2009-01-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "CERTIFIED PEDORTHIST",
        "authorized_official_telephone_number": "636-561-2204",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.PED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "013370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake St Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.