Healthcare Provider Details

I. General information

NPI: 1679797237
Provider Name (Legal Business Name): SAINT LOUIS CONNECTCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

IV. Provider business mailing address

PO BOX 795120
SAINT LOUIS MO
63179-0795
US

V. Phone/Fax

Practice location:
  • Phone: 314-879-6308
  • Fax: 314-879-6372
Mailing address:
  • Phone: 314-879-6308
  • Fax: 314-879-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number199-0
License Number StateMO

VIII. Authorized Official

Name: MRS. TERRI DEHNE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 314-879-6308