Fortieth & Vineyard Company LLC

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

Legal business name

FORTIETH & VINEYARD COMPANY LLC

Practice address

10781 North Outer 40 Road
117
Chesterfield, MO 63005

Phone

(314) 496-0178

NPI assigned

Jul 24, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Stacey Yvonne Pegues, SPECIALISTNPI 1487347035

Title

Cranial Prosthesis Specialists

Phone

(314) 496-0178

Specialties & licenses 1

Addresses

Other names 1

• Wigs 2 Wellness Doing business as

Practitioners 1

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

• Stacey Yvonne Pegues

  • Prosthetics Case Management
  • Chesterfield, MO
  • NPI 1487347035
  NPD Authorized official

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1851071898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2369 WESFORD DR",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630434147",
            "telephone_number": "314-496-0178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10781 NORTH OUTER 40 ROAD",
            "address_2": "117",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "63005",
            "telephone_number": "314-496-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTIETH & VINEYARD COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "PEGUES",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "CRANIAL PROSTHESIS SPECIALISTS",
        "authorized_official_telephone_number": "314-496-0178",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SPECIALIST"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wigs 2 Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eric Matthew Foss, D.D.S., M.S.

• Prosthetics Case Management in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Prosthetics Case Management in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.