Healthcare Provider Details

I. General information

NPI: 1518062017
Provider Name (Legal Business Name): ST. JOHN'S CARDIOVASCULAR ASSOCIATES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SAINT LUKES CENTER DR SUITE 501
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

121 SAINT LUKES CENTER DR SUITE 501
CHESTERFIELD MO
63017-3509
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-3500
  • Fax: 314-485-3520
Mailing address:
  • Phone: 314-485-3500
  • Fax: 314-485-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. LESLIE E. MEZEI
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 314-485-3500