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Contact Information

PROVIDENT
3675 W OUTER RD
203
ARNOLD, MO63010-5232
 Phone: 314-898-0102
 Fax: 636-296-3249
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Preferred Provider Organization

305R00000X
 

Hospice Care, Community Based

251G00000X B4[14] Hospice
Indicates primary specialty

NPI Profile & details for PROVIDENT

NPI Number 1316005473
LBN Legal business name PROVIDENT
Authorized official KRISTIN BULIN - (DIRECTOR OF COUNSELING DIVISION)
Entity Organization
Organization subpart 1 No
Enumeration date 12/04/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
MO License # 002589
MO License # SW002589
MO Medicaid 496768326
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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