The Youthful Body Medical Spa

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

115456 Issued in MO

Legal business name

THE YOUTHFUL BODY MEDICAL SPA

Practice address

10287 Clayton Rd
Suite 200
Saint Louis, MO 63124-1172

Phone

(314) 692-2639

Fax

(314) 692-2649

NPI assigned

Apr 24, 2009

Organization subpart

No

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

Authorized official

Name

Erick Falconer, M.D.

Title

Medical Director

Phone

(314) 692-2639

Specialties & licenses 1

Addresses

Tax ID family

The Youthful Body Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The Youthful Body, Inc.

  • Medical Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1346576709
  NPD tax ID

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1447494133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 BELLERIVE ACRES",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631214330",
            "telephone_number": "314-495-2700",
            "fax_number": "314-389-6023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10287 CLAYTON RD",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631241172",
            "telephone_number": "314-692-2639",
            "fax_number": "314-692-2649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE YOUTHFUL BODY MEDICAL SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "FALCONER",
        "authorized_official_first_name": "ERICK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "314-692-2639",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MO",
            "license": "115456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Therapy Project
• The War Room
• The Wellness Partnership Group LLC
• The Whiteville Drugstore, LLC
• The Whole You Wellness and Counseling Center LLC
• The Youthful Body, Inc.
• Tama Saint The, MD
• Clay Dalton Thebeau, ATC
• Clayton E. Thebeau, D.O.
• Kayla Noelle Theberge, LPC

• Multi-Specialty Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Multi-Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.