Healthcare Provider Details

I. General information

NPI: 1366692915
Provider Name (Legal Business Name): DES PERES HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD ATTENTION MEDICAL EDUCATION
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-9491
  • Fax:
Mailing address:
  • Phone: 573-756-6751
  • Fax: 573-756-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAMESY CHARLES SMITH
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 573-760-8605