Healthcare Provider Details

I. General information

NPI: 1942486634
Provider Name (Legal Business Name): ST. ANTHONY'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

10016 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1000
  • Fax: 314-525-1886
Mailing address:
  • Phone: 314-525-1000
  • Fax: 314-525-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberCS001728
License Number StateMO

VIII. Authorized Official

Name: MS. ANN MARIE POTCHEN
Title or Position: CLINICAL MANAGER
Credential: LCSW
Phone: 314-525-1000