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General NPI Number Information
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NPI Number | 1013057686
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Entity Type | Organization
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Legal Business Name | ST.JOSEPH HEALTH CENER WOMENS AND CHILDRENS SERVICES CLINIC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 MEDICAL PLZ STE 221
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1483
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Country | US
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Telephone | 636-561-2229
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Fax | 636-625-5288
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Provider Business Mailing Address
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Address Line | 300 MEDICAL PLZ STE 221
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1483
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Country | US
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Telephone | 636-561-2229
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Fax | 636-625-5288
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Authorized Official
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Title or Position | NETWORK VICE PRESIDENT
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Name | MRS. DIANNE P BARRY
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Credential |
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Telephone | 314-989-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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