Healthcare Provider Details

I. General information

NPI: 1770252090
Provider Name (Legal Business Name): CITY OF ST LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 08/24/2021
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
SAINT LOUIS MO
63103-2620
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

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