1518062017 NPI number — ST. JOHN'S CARDIOVASCULAR ASSOCIATES L.L.C.

Table of content: (NPI 1518062017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518062017 NPI number — ST. JOHN'S CARDIOVASCULAR ASSOCIATES L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN'S CARDIOVASCULAR ASSOCIATES L.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:
1518062017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 SAINT LUKES CENTER DR
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-485-3500
Provider Business Mailing Address Fax Number:
314-485-3520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 SAINT LUKES CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-485-3500
Provider Business Practice Location Address Fax Number:
314-485-3520
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEZEI
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
314-485-3500

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , 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)





Copyright © 2007-2025 www.npivalidator.com