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General NPI Number Information
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NPI Number | 1033180526
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Entity Type | Organization
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Legal Business Name | VAMC ST. LOUIS MO
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 314-652-4100
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Fax | 314-289-7034
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Provider Business Mailing Address
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Address Line | 1424 DALE DR
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City | TROY
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State | IL
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Zip | 62294-3614
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Country | US
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Telephone | 618-667-0404
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Fax | 314-289-7034
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Authorized Official
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Title or Position | ORTHO PHYSICIAN ASSISTANT
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Name | MRS. ROSEMARY ANN ALEXANDER-LEDBETTER
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Credential | PAC
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Telephone | 314-652-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State |
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