Healthcare Provider Details

I. General information

NPI: 1487678165
Provider Name (Legal Business Name): ST. LOUIS HEART & VASCULAR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD STE 304E
SAINT LOUIS MO
63136-6150
US

IV. Provider business mailing address

11155 DUNN RD STE 304E
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-0911
  • Fax: 314-741-0501
Mailing address:
  • Phone: 314-741-0911
  • Fax: 314-741-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN THOMAS
Title or Position: DIRECTOR OF PAYER CONTRACTING
Credential:
Phone: 224-285-6266