Healthcare Provider Details

I. General information

NPI: 1245791474
Provider Name (Legal Business Name): WOMEN'S CARE OF ST LUKE'S, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD STE 55W
CHESTERFIELD MO
63017-3664
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 55W
CHESTERFIELD MO
63017-3664
US

V. Phone/Fax

Practice location:
  • Phone: 314-542-4953
  • Fax: 314-590-5942
Mailing address:
  • Phone: 314-542-4953
  • Fax: 314-590-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES SNIDER
Title or Position: V. P. PHYSICIAN NETWORK
Credential:
Phone: 636-685-7804