Healthcare Provider Details

I. General information

NPI: 1154665248
Provider Name (Legal Business Name): INSTITUTE FOR RESEARCH AND EDUCATION IN FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ARSENAL ST
SAINT LOUIS MO
63118-2001
US

IV. Provider business mailing address

4590 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1832
US

V. Phone/Fax

Practice location:
  • Phone: 314-773-6100
  • Fax: 314-664-6200
Mailing address:
  • Phone: 314-849-7669
  • Fax: 314-849-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY C CAPPEL
Title or Position: VP & CBO
Credential:
Phone: 314-849-7669