Healthcare Provider Details

I. General information

NPI: 1508941188
Provider Name (Legal Business Name): ST. JOHN'S MERCY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3417
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6030
  • Fax:
Mailing address:
  • Phone: 314-205-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOM EDELSTEIN
Title or Position: VICE PRESIDENT OPERATIONS
Credential:
Phone: 314-729-4668