=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154722841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MISSOURI BAPTIST MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2014
-----------------------------------------------------
Last Update Date | 05/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 S KINGSHIGHWAY BLVD STE 1500
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-657-9000
-----------------------------------------------------
Fax | 314-525-0416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1234 S KINGSHIGHWAY BLVD STE 1500
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-657-9000
-----------------------------------------------------
Fax | 314-525-0416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANN ABAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-996-8401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 20014032494
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------