Seniorwell of Missouri LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SENIORWELL OF MISSOURI LLC

Practice address

4625 Lindell Blvd FL 2
Saint Louis, MO 63108-3725

Phone

(844) 882-3127

NPI assigned

May 21, 2018

Organization subpart

No

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

Authorized official

Name

Kenneth King

Title

Owner

Phone

(844) 882-3127

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526860800000",
    "number": "1790276277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD STE 1000",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "844-882-3127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD FL 2",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083725",
            "telephone_number": "844-882-3127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIORWELL OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2018-05-21",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "844-882-3127"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.