Healthcare Provider Details

I. General information

NPI: 1235225475
Provider Name (Legal Business Name): MERCY CLINIC CHILDREN'S HOSPITALISTS - ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 6006-B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 6006-B
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6299
  • Fax: 314-251-4450
Mailing address:
  • Phone: 314-251-6299
  • Fax: 314-251-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A. JOHNSTON
Title or Position: PRESIDENT, MERCY HOSPITAL ST. LOUIS
Credential:
Phone: 314-251-1932