Healthcare Provider Details

I. General information

NPI: 1013677293
Provider Name (Legal Business Name): SOUTHAMPTON COMMUNITY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 HAMPTON AVE
SAINT LOUIS MO
63139-2935
US

IV. Provider business mailing address

2340 HAMPTON AVE
SAINT LOUIS MO
63139-2935
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-2200
  • Fax: 314-647-4172
Mailing address:
  • Phone: 314-647-2200
  • Fax: 314-647-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW MARSHALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-647-2200