Healthcare Provider Details

I. General information

NPI: 1659155950
Provider Name (Legal Business Name): ST. LOUIS FERTILITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15320 CONWAY RD
CHESTERFIELD MO
63017-2019
US

IV. Provider business mailing address

6720 N SCOTTSDALE RD STE 160
SCOTTSDALE AZ
85253-4421
US

V. Phone/Fax

Practice location:
  • Phone: 314-464-3979
  • Fax: 314-464-4288
Mailing address:
  • Phone: 480-321-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA SELLERS
Title or Position: DIRECTOR, RCM
Credential:
Phone: 480-321-6118