Provider Demographics
NPI:1275324931
Name:SECIC, ENES
Entity type:Individual
Prefix:MR
First Name:ENES
Middle Name:
Last Name:SECIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 AUTUMN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5578
Mailing Address - Country:US
Mailing Address - Phone:314-817-6728
Mailing Address - Fax:
Practice Address - Street 1:1011 AUTUMN VALLEY CT
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5578
Practice Address - Country:US
Practice Address - Phone:314-817-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBD4S7B343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)