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Contact Information

MIND BODY ENDURANCE LLC
16 N GORE AVE STE 204
SAINT LOUIS, MO63119-2315
 Phone: 513-505-2160
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Exercise & Sports

103TE1100X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for MIND BODY ENDURANCE LLC

NPI # 1053018903
LBN Legal business name MIND BODY ENDURANCE LLC
Authorized official RILEY NICKOLS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/10/2023
Last updated 02/10/2023 - About 3 years ago
Identifiers
MO Medicaid 1790019511
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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