Healthcare Provider Details

I. General information

NPI: 1982756771
Provider Name (Legal Business Name): SOUTHAMPTON HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 HAMPTON AVE
SAINT LOUIS MO
63139-2909
US

IV. Provider business mailing address

PO BOX 952024
SAINT LOUIS MO
63195-2024
US

V. Phone/Fax

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

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: MR. DAVID PRELUTSKY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 314-647-2200