Healthcare Provider Details

I. General information

NPI: 1467461434
Provider Name (Legal Business Name): MISSOURI BAPTIST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5000
  • Fax: 314-996-3610
Mailing address:
  • Phone: 314-996-5000
  • Fax: 314-996-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. ANN ABAD
Title or Position: PRESIDENT
Credential:
Phone: 314-996-8401