Healthcare Provider Details

I. General information

NPI: 1093844185
Provider Name (Legal Business Name): WOMENS CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 FIRST EXECUTIVE AVE
SAINT PETERS MO
63376-1697
US

IV. Provider business mailing address

209 FIRST EXECUTIVE AVE
SAINT PETERS MO
63376-1697
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-1047
  • Fax: 636-939-4257
Mailing address:
  • Phone: 636-936-8777
  • Fax: 636-939-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number104103
License Number StateMO

VIII. Authorized Official

Name: JANET MATUSZEK
Title or Position: OWNER / DO
Credential:
Phone: 636-936-8777