Healthcare Provider Details

I. General information

NPI: 1992322739
Provider Name (Legal Business Name): ALEXIA LAMBOS GEORGES CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIA LAMBOS CCP

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

14002 NEW BEDFORD CT
CHESTERFIELD MO
63017-3453
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-766-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number1999136721
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: