Healthcare Provider Details

I. General information

NPI: 1972854032
Provider Name (Legal Business Name): WEST COUNTY OBGYN SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 75B
SAINT LOUIS MO
63141-8251
US

IV. Provider business mailing address

621 SOUTH NEW BALLAS ROAD, SUITE 75 B
SAINT LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7564
  • Fax: 314-251-7554
Mailing address:
  • Phone: 314-251-7564
  • Fax: 314-251-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2012012819
License Number StateMO

VIII. Authorized Official

Name: MS. SUSAN PIGNOTTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-251-7564