1023425329 NPI number — ST. ANTHONY'S PHYSICIAN ORGANIZATION

Table of content: DR. JAIRO DE JESUS CASTROLONDONO MD (NPI 1730239310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023425329 NPI number — ST. ANTHONY'S PHYSICIAN ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. ANTHONY'S PHYSICIAN ORGANIZATION
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:
Provider Other Organization Name Type Code:
6
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:
1023425329
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:
10010 KENNERLY RD
Provider Second Line Business Mailing Address:
ATTN: CANCER CARE CENTER
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-525-1688
Provider Business Mailing Address Fax Number:
314-525-1689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 KENNERLY RD
Provider Second Line Business Practice Location Address:
ATTN: CANCER CARE CENTER
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-525-1688
Provider Business Practice Location Address Fax Number:
314-525-1689
Provider Enumeration Date:
07/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MATEJKA
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO EAST COMMUNITIES & SFO
Authorized Official Telephone Number:
314-251-1958

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X , with the licence number:  273-39 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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