Healthcare Provider Details

I. General information

NPI: 1295869824
Provider Name (Legal Business Name): RECTAL DIAGNOSTICS & TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 DOUGHERTY FERRY RD SUITE 107
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

2315 DOUGHERTY FERRY RD SUITE 107
SAINT LOUIS MO
63122-3313
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-7570
  • Fax: 314-966-7788
Mailing address:
  • Phone: 314-966-7570
  • Fax: 314-966-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberR5J14
License Number StateMO

VIII. Authorized Official

Name: DR. STEVEN MARK ABBADESSA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 314-966-7570