Healthcare Provider Details

I. General information

NPI: 1164683025
Provider Name (Legal Business Name): SHAINA ROSE ECKHOUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 02/08/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N MASON RD DIV SURG MIS, STE 320
SAINT LOUIS MO
63141-6431
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8109-0037-09
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8877
  • Fax: 877-991-4780
Mailing address:
  • Phone: 314-454-7224
  • Fax: 877-991-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2016014776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: