1407216336 NPI number — ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES, L.C.

Table of content: (NPI 1407216336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407216336 NPI number — ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES, L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES, L.C.
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:
1407216336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9735 LANDMARK PARKWAY DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63127-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-525-1328
Provider Business Mailing Address Fax Number:
314-525-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 KENNERLY RD
Provider Second Line Business Practice Location Address:
3 SOUTHBRIDGE
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:
314-525-1328
Provider Business Practice Location Address Fax Number:
314-525-1378
Provider Enumeration Date:
03/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DUNGER
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR - FINANCE
Authorized Official Telephone Number:
314-364-3707

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , 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)

  • Identifier: MA3704 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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