Healthcare Provider Details

I. General information

NPI: 1346650884
Provider Name (Legal Business Name): MATTHEW T. RICKS DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DOUGHERTY FERRY RD 430
SAINT LOUIS MO
63122-3325
US

IV. Provider business mailing address

2355 DOUGHERTY FERRY RD 430
SAINT LOUIS MO
63122-3325
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-8410
  • Fax: 314-965-8756
Mailing address:
  • Phone: 314-965-8410
  • Fax: 314-965-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW RICKS
Title or Position: OWNER
Credential: DO
Phone: 314-965-8410