Healthcare Provider Details

I. General information

NPI: 1679426514
Provider Name (Legal Business Name): ST LUKES IMMEDIATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 OLIVE BLVD
CREVE COEUR MO
63141-7111
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-2306
  • Fax: 314-336-6224
Mailing address:
  • Phone: 314-576-2306
  • Fax: 314-336-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY LETT
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 636-685-7804