Healthcare Provider Details

I. General information

NPI: 1770579195
Provider Name (Legal Business Name): JENNINGS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 W FLORISSANT AVE
SAINT LOUIS MO
63136-3638
US

IV. Provider business mailing address

6917 W FLORISSANT AVE
SAINT LOUIS MO
63136-3638
US

V. Phone/Fax

Practice location:
  • Phone: 314-383-1100
  • Fax: 314-383-4929
Mailing address:
  • Phone: 314-383-1100
  • Fax: 314-383-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NARGIS J AHMAD
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-383-1100