1013935816 NPI number — ST. LOUIS HEART INSTITUTE CARDIOTHORACIC SURGEONS, INC.

Table of content: (NPI 1013935816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013935816 NPI number — ST. LOUIS HEART INSTITUTE CARDIOTHORACIC SURGEONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LOUIS HEART INSTITUTE CARDIOTHORACIC SURGEONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. LOUIS HEART INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013935816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 MEXICO RD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-1666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-909-0747
Provider Business Mailing Address Fax Number:
844-535-9135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 MEXICO RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-909-0747
Provider Business Practice Location Address Fax Number:
844-535-9135
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
JAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
314-909-0747

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  R5C87 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: R5C87 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208G00000X , with the licence number: R1A72 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 2003015803 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 20060105803 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1942234331 . This is a "NPI GORDON KNIGHT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 242527208 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013935816 . This is a "NPI GROUP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 990000841 . This is a "PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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