1275957169 NPI number — INTEGRAMED MEDICAL MISSOURI, LLC

Table of content: MR. KENNETH LOWELL FREEDMAN LICSW (NPI 1780731539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275957169 NPI number — INTEGRAMED MEDICAL MISSOURI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRAMED MEDICAL MISSOURI, LLC
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:
STL FERTILITY
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:
1275957169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N NEW BALLAS ROAD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-983-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N NEW BALLAS ROAD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-983-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTE
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER/OPERATIONS DIRECTOR
Authorized Official Telephone Number:
314-983-9000

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , 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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