Provider Demographics
NPI:1609140359
Name:ABUNDANT HEALTH CARE SERVICES
Entity type:Organization
Organization Name:ABUNDANT HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:VANTRICE
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-664-5155
Mailing Address - Street 1:1712 S TUCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-3427
Mailing Address - Country:US
Mailing Address - Phone:314-334-8000
Mailing Address - Fax:866-255-9006
Practice Address - Street 1:212 CHARMERS CT
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7129
Practice Address - Country:US
Practice Address - Phone:314-664-5155
Practice Address - Fax:866-255-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302R00000X
MO302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization