Healthcare Provider Details

I. General information

NPI: 1396210852
Provider Name (Legal Business Name): RURAL PARISH CLINIC OF THE ARCHDIOCESE OF ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 CREST ROAD
CADET MO
63630-9629
US

IV. Provider business mailing address

20 ARCHBISHOP MAY DRIVE
ST. LOUIS MO
63119
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-9610
  • Fax: 573-438-3685
Mailing address:
  • Phone: 314-792-7717
  • Fax: 314-289-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK G. BIRA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-979-4972