Healthcare Provider Details

I. General information

NPI: 1790441046
Provider Name (Legal Business Name): COMPLEX ILLNESS MANAGEMENT OF ST LUKES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 620S
CHESTERFIELD MO
63017-3619
US

IV. Provider business mailing address

121 SAINT LUKES CENTER DR STE 200
CHESTERFIELD MO
63017-3518
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7786
  • Fax: 314-205-6377
Mailing address:
  • Phone: 636-685-7804
  • Fax: 314-576-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN R. HASKELL
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 314-205-6444