Healthcare Provider Details

I. General information

NPI: 1285206169
Provider Name (Legal Business Name): CITY OF ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 MARKET ST RM 4086
SAINT LOUIS MO
63103-2614
US

IV. Provider business mailing address

1520 MARKET ST RM 4086
SAINT LOUIS MO
63103-2614
US

V. Phone/Fax

Practice location:
  • Phone: 314-657-1673
  • Fax: 314-612-5915
Mailing address:
  • Phone: 314-657-1673
  • Fax: 314-612-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANITA JENKINS
Title or Position: INFORMATION SYSTEMS COORDINATOR
Credential:
Phone: 314-657-1673