Healthcare Provider Details

I. General information

NPI: 1194683359
Provider Name (Legal Business Name): ALEC BASTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 W PINE BLVD APT 3G APT 3G
SAINT LOUIS MO
63108-1472
US

IV. Provider business mailing address

4949 W PINE BLVD APT 3G
SAINT LOUIS MO
63108-1472
US

V. Phone/Fax

Practice location:
  • Phone: 920-471-8965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: