Healthcare Provider Details

I. General information

NPI: 1588026421
Provider Name (Legal Business Name): ST. ANTHONY'S PHYSICIAN ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SOUTHFORK RD STE 200/220
SAINT LOUIS MO
63128-3201
US

IV. Provider business mailing address

9735 LANDMARK PARKWAY DR STE 200
SAINT LOUIS MO
63127-1646
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5942
  • Fax: 314-543-5947
Mailing address:
  • Phone: 314-543-6985
  • Fax: 314-543-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL MATEJKA
Title or Position: CFO EAST COMMUNITIES & SFO
Credential:
Phone: 314-251-1958