Healthcare Provider Details

I. General information

NPI: 1730342163
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS OF ST. LOUIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY ROAD
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 816-550-0003
  • Fax: 630-734-1560
Mailing address:
  • Phone: 816-550-0003
  • Fax: 630-734-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON M SCHLAUTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 816-550-0003