NPIMap

Organization Active NPI

Dedicated Missouri Holding, LLC

Doing business as Dedicated Senior Medical Center Page Boulevard

  • Non-Pharmacy Dispensing Site
  • Saint Louis, MO
National Provider Identifier
1558909150
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
DEDICATED MISSOURI HOLDING, LLC
Doing business as
Dedicated Senior Medical Center Page Boulevard
Practice address
3649 Page Blvd
Saint Louis, MO 63113-3807
Phone
(314) 328-0144
NPI assigned
Dec 13, 2019
Organization subpart
Yes
Parent organization
DEDICATED MISSOURI HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

3649 Page Blvd
Saint Louis, MO 63113-3807

Mailing address

1395 NW 167TH St
Miami, FL 33169-5710

Other names 1

  • Dedicated Senior Medical Center Page Boulevard 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
26D2189146Dedicated Senior Medical Center-Page3649 Page Blvd, Saint Louis, MO 63113Certificate of waiverJul 26, 2026

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.

Practitioners & affiliated clinicians

Practitioners 8

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": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1558909150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331695710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3649 PAGE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631133807",
            "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": "2019-12-13",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "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 Page Boulevard",
            "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 Dec 13, 2019; 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.