Healthcare Provider Details

I. General information

NPI: 1184686511
Provider Name (Legal Business Name): REPRODUCTIVE HEALTH SERVICES OF PLANNED PARENTHOD GREAT RIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 FOREST PARK AVE
SAINT LOUIS MO
63108-2810
US

IV. Provider business mailing address

4251 FOREST PARK AVE
SAINT LOUIS MO
63108-2810
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-7526
  • Fax: 314-531-3190
Mailing address:
  • Phone: 314-531-7526
  • Fax: 314-531-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number14
License Number StateMO

VIII. Authorized Official

Name: RICHARD MUNIZ
Title or Position: GENERAL COUNSEL
Credential:
Phone: 314-828-1804