Healthcare Provider Details

I. General information

NPI: 1942256250
Provider Name (Legal Business Name): CRITICAL CARE SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CITYPLACE DRIVE SUITE 570
ST. LOUIS MO
63141-7067
US

IV. Provider business mailing address

ONE CITYPLACE DRIVE SUITE 570
SAINT LOUIS MO
63141-7067
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-6000
  • Fax: 866-497-1239
Mailing address:
  • Phone: 314-514-6060
  • Fax: 866-497-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier508903408
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: ISABELLE C KOPEC
Title or Position: PRESIDENT
Credential: MD
Phone: 314-514-6000