NPIMap

Organization Active NPI

Dedicated Missouri Holding, LLC

  • Non-Pharmacy Dispensing Site
  • Saint Louis, MO
National Provider Identifier
1154968196
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
DEDICATED MISSOURI HOLDING, LLC
Practice address
3721 S Grand Blvd
Saint Louis, MO 63118-3405
Phone
(314) 328-0144
NPI assigned
Dec 10, 2019
Organization subpart
Yes
Parent organization
DEDICATED MISSOURI HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Authorized official

Name
Mary Chen
Title
Owner
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

3721 S Grand Blvd
Saint Louis, MO 63118-3405

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Dedicated Senior Medical Center Tower Grove Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2189148Dedicated Senior Medical Center-Tower Grove3721 S Grand Blvd, Saint Louis, MO 63118Certificate of waiverJul 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dedicated Missouri HLDG LLC6 organizations share this tax ID, including this one
Part of
Dedicated Missouri HLDG LLC

Other organizations with this tax ID 5

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

Locations

3721 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 328-0144

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1154968196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631183405",
            "telephone_number": "314-328-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED MISSOURI HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED MISSOURI HOLDING, LLC",
        "enumeration_date": "2019-12-10",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center Tower Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.