Healthcare Provider Details

I. General information

NPI: 1932024304
Provider Name (Legal Business Name): IVY ST LOUIS SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N LINDBERGH BLVD
CREVE COEUR MO
63141-7811
US

IV. Provider business mailing address

710 CENTRAL ST STE 79445
KANSAS CITY MO
64105-1682
US

V. Phone/Fax

Practice location:
  • Phone: 858-925-5330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CIRILLO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 858-925-5330