Healthcare Provider Details

I. General information

NPI: 1396981726
Provider Name (Legal Business Name): ST. LUKES PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-5363
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3417
US

V. Phone/Fax

Practice location:
  • Phone: 314-423-8624
  • Fax: 314-423-2158
Mailing address:
  • Phone: 314-434-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SPILLERS
Title or Position: CFO
Credential:
Phone: 314-434-1500