Healthcare Provider Details

I. General information

NPI: 1851437362
Provider Name (Legal Business Name): SOUTHWEST PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 LANSDOWNE AVE
SAINT LOUIS MO
63109-2654
US

IV. Provider business mailing address

6526 LANSDOWNE AVE
SAINT LOUIS MO
63109-2654
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-8777
  • Fax: 314-353-8772
Mailing address:
  • Phone: 314-353-8777
  • Fax: 314-353-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEROME H. O'NEIL JR.
Title or Position: PARTNER
Credential: M.D.
Phone: 314-353-8777