Healthcare Provider Details

I. General information

NPI: 1790743029
Provider Name (Legal Business Name): JOHN T SCHWENT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DEPAUL DRIVE DEPAUL HEALTH CENTER
BRIDGETON MO
63044
US

IV. Provider business mailing address

PO BOX 4853 DEPT 4036 MIDWEST EMERGENCY ASSOCIATES - DEPAUL LLC
OAK BROOK IL
60522
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax: 630-734-1560
Mailing address:
  • Phone: 636-734-0200
  • Fax: 630-734-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6301
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: