Healthcare Provider Details

I. General information

NPI: 1407076631
Provider Name (Legal Business Name): ST. MARY'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

IV. Provider business mailing address

7805 STANFORD AVE
SAINT LOUIS MO
63130-3611
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8000
  • Fax:
Mailing address:
  • Phone: 314-862-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2002001971
License Number StateMO

VIII. Authorized Official

Name: DR. JAN AXELBAUM
Title or Position: INTERNAL MEDICINE RESIDENT
Credential:
Phone: 314-862-6170