Healthcare Provider Details

I. General information

NPI: 1578711420
Provider Name (Legal Business Name): HAMPTON VILLAGE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HAMPTON VILLAGE PLZ 220
SAINT LOUIS MO
63109-2128
US

IV. Provider business mailing address

16 HAMPTON VILLAGE PLZ STE 220
SAINT LOUIS MO
63109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-2004
  • Fax: 314-351-0347
Mailing address:
  • Phone: 314-351-2004
  • Fax: 314-351-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008015366
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2008015366
License Number StateMO

VIII. Authorized Official

Name: DR. MELISSA A. WHITSON
Title or Position: PEDIATRICIAN/OWNER
Credential: D.O.
Phone: 314-351-2004