| Organization Name: | STACEY'S HEART HEALTH SERVICES, LLC |
| NPI Number: | 1447619325 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACEY MICHELLE HARVEY (CEO) |
| Mailing Address: | 7584 Olive Blvd Suite 210 University City |
| State: | MO US |
| Postal Code: | 631301600 |
| Phone Number: | 3148999211 |
| Fax Number: | 3144807069 |
| NPI Enumeration Date: | 02/19/2016 |
| NPI Last Update Date: | 02/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 2000156514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |