MEDICARE: WESTEND CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	17053498	MO

General Provider Information

NPI Number	:	1730204967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTEND CLINIC

Provider Business Mailing Address
First Line	:	5736 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2457
Country	:	US
Telephone Number	:	314-381-0560
Fax Number	:	314-381-2747

Provider Business Practice Location Address
First Line	:	5736 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2457
Country	:	US
Telephone Number	:	314-381-0560
Fax Number	:	314-381-2747

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WARDELL JOHN CARTER
Credential	:
Telephone Number	:	314-381-0560

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	05/15/2008

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Directions to “WESTEND CLINIC ” Practice Location

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