Healthcare Provider Details

I. General information

NPI: 1518368265
Provider Name (Legal Business Name): CHESTERFIELD CARDIAC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD 44W
CHESTERFIELD MO
63017-3662
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-8788
  • Fax: 314-991-8960
Mailing address:
  • Phone: 314-432-2580
  • Fax: 314-991-8960

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 Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MORTON RINDER
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 314-568-5858