Healthcare Provider Details

I. General information

NPI: 1538413406
Provider Name (Legal Business Name): PCW ST LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLIVE BLVD
UNIVERSITY CITY MO
63130-2030
US

IV. Provider business mailing address

7700 OLIVE BLVD
UNIVERSITY CITY MO
63130-2030
US

V. Phone/Fax

Practice location:
  • Phone: 630-333-2540
  • Fax:
Mailing address:
  • Phone: 314-449-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA STRIMPEL
Title or Position: PROGRAM DIRECTOR
Credential: MS, RD, LD
Phone: 314-449-6464