Healthcare Provider Details

I. General information

NPI: 1295963940
Provider Name (Legal Business Name): ST. ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LEMAY FERRY ROAD SUITE 216
ST. LOUIS MO
63125-3900
US

IV. Provider business mailing address

2900 LEMAY FERRY ROAD SUITE 216
ST. LOUIS MO
63125-3900
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5988
  • Fax: 314-416-8547
Mailing address:
  • Phone: 314-543-5988
  • Fax: 314-416-8547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. DAVE HINKLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-543-5988