Healthcare Provider Details

I. General information

NPI: 1801983259
Provider Name (Legal Business Name): CHILDREN'S CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD SUITE 100
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

8888 LADUE RD SUITE 100
SAINT LOUIS MO
63124-2056
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-4050
  • Fax: 314-862-1141
Mailing address:
  • Phone: 314-862-4050
  • Fax: 314-862-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DEBBIE BAER
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-862-4050