=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083930754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANSTEY INTERNAL MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2010
-----------------------------------------------------
Last Update Date | 04/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3009 N BALLAS RD STE 215B
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-1964
-----------------------------------------------------
Fax | 314-645-3345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3009 N BALLAS RD STE 215B
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63131-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-1964
-----------------------------------------------------
Fax | 314-645-3345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH G ANSTEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 314-432-1964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD104521
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------