Healthcare Provider Details

I. General information

NPI: 1164976494
Provider Name (Legal Business Name): CAREATC-ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12633 OLIVE BLVD
SAINT LOUIS MO
63141-6313
US

IV. Provider business mailing address

12633 OLIVE BLVD
SAINT LOUIS MO
63141-6313
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KEITH GUCWA
Title or Position: DIRECTOR OF PURCHASING AND FACILITI
Credential:
Phone: 918-779-7416