Healthcare Provider Details

I. General information

NPI: 1114348380
Provider Name (Legal Business Name): ST LOUIS HEART AND VASCULAR P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MCKELVEY RD
BRIDGETON MO
63044-2527
US

IV. Provider business mailing address

3550 MCKELVEY RD
BRIDGETON MO
63044-2527
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-0911
  • Fax: 314-741-0501
Mailing address:
  • Phone: 314-741-0911
  • Fax: 314-741-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number132113
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN THOMAS
Title or Position: VP OF MANAGED CARE
Credential:
Phone: 224-285-6266