MEDICARE: ST LOUIS NEUROLOGY ASSOCIATES INC

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	2084N0400X	Neurology Physician	R7491	MO

General Provider Information

NPI Number	:	1811200983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LOUIS NEUROLOGY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 4340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-0140
Country	:	US
Telephone Number	:	314-849-5665
Fax Number	:	314-849-0274

Provider Business Practice Location Address
First Line	:	12810 TESSON FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2913
Country	:	US
Telephone Number	:	314-849-5665
Fax Number	:	314-849-0274

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN J O'KEEFE III
Credential	:	M.D.
Telephone Number	:	314-849-5665

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	05/31/2011

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