Healthcare Provider Details

I. General information

NPI: 1720338874
Provider Name (Legal Business Name): INTERNATIONAL INSTITUTE OF METROPOLITAN SAINT LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 S GRAND BLVD
SAINT LOUIS MO
63118-3404
US

IV. Provider business mailing address

3654 S GRAND BLVD
SAINT LOUIS MO
63118-3404
US

V. Phone/Fax

Practice location:
  • Phone: 314-773-9090
  • Fax: 314-773-6047
Mailing address:
  • Phone: 314-773-9090
  • Fax: 314-773-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name: ANNA CROSSLIN
Title or Position: PRESIDENT
Credential:
Phone: 314-773-9090