1063458305 NPI number — ST ANN OB GYN INC

Table of content: (NPI 1063458305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063458305 NPI number — ST ANN OB GYN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST ANN OB GYN 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:
Provider Other Organization Name Type Code:
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:
1063458305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 N BALLAS ROAD
Provider Second Line Business Mailing Address:
SUITE 356C
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-432-2880
Provider Business Mailing Address Fax Number:
314-432-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3009 N BALLAS ROAD
Provider Second Line Business Practice Location Address:
SUITE 356C
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-432-2880
Provider Business Practice Location Address Fax Number:
314-432-4810
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTERUBIO
Authorized Official First Name:
FRED
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP VICE PRESIDENT
Authorized Official Telephone Number:
314-432-2880

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4217036 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101340 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5143 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0700216 . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3951 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46319 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4270227 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0700217 . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112754 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112759 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: SP15671 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: SP15678 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0700217 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100174 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45077 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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