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General NPI Number Information
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NPI Number | 1093092611
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Entity Type | Organization
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Legal Business Name | ST LOUIS BARIATRICS LLC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 10296 BIG BEND RD STE 206
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City | SAINT LOUIS
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State | MO
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Zip | 63122-6582
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Country | US
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Telephone | 314-366-4874
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Fax | 314-366-4875
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Provider Business Mailing Address
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Address Line | PO BOX 270419
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City | SAINT LOUIS
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State | MO
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Zip | 63127-0419
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Country | US
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Telephone | 314-366-4874
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Fax | 314-366-4875
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LORETTA BENEDICK
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Credential |
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Telephone | 314-366-4874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2011030112
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License Number State | MO
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