Healthcare Provider Details

I. General information

NPI: 1679084206
Provider Name (Legal Business Name): COMPASSIONATE HEALTH CARE OF ST LOUIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 CRESCENT DR
SAINT LOUIS MO
63129-1000
US

IV. Provider business mailing address

10175 TANBRIDGE RD
SAINT LOUIS MO
63128-2630
US

V. Phone/Fax

Practice location:
  • Phone: 314-939-1322
  • Fax: 314-939-1323
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number001372489
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number001372489
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number001372489
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number001372489
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number001372489
License Number StateMO

VIII. Authorized Official

Name: CHRIS LEARA
Title or Position: PRESIDENT
Credential:
Phone: 314-238-7400