1487819512 NPI number — ST. ANTHONY'S PHYSICIAN ORGANIZATION

Table of content: (NPI 1487819512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487819512 NPI number — ST. ANTHONY'S PHYSICIAN ORGANIZATION

Organization/Personal Information

Employer Identification Number (EIN):
N/A
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:
MERCY CLINIC SOUTH PHYSICIANS
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:
1487819512
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:
10296 BIG BEND BLVD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-543-5943
Provider Business Mailing Address Fax Number:
314-543-5953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10296 BIG BEND BLVD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
KIRKWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-543-5943
Provider Business Practice Location Address Fax Number:
314-543-5953
Provider Enumeration Date:
07/29/2008

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: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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