1780945022 NPI number — ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES, LC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780945022 NPI number — ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES, LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES, LC
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. ANTHONY'S AUDIOLOGY AND HEARING CENTER
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:
1780945022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 SOUTHFORK RD
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-525-4327
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12700 SOUTHFORK RD
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-525-4327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HINKLE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
314-543-5988

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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