Healthcare Provider Details

I. General information

NPI: 1053206375
Provider Name (Legal Business Name): COUNTY OF ST LOUIS DIVISION OF FISCAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1810
US

IV. Provider business mailing address

6121 N HANLEY RD
BERKELEY MO
63134-2003
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-0400
  • Fax: 314-615-8303
Mailing address:
  • Phone: 314-615-0877
  • Fax: 314-615-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DENISE WILSON
Title or Position: REVENUE MANAGER
Credential:
Phone: 314-615-0877