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General NPI Number Information
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NPI Number | 1174505127
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Entity Type | Organization
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Legal Business Name | ST LOUIS MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD SUITE 100B
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2322
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Country | US
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Telephone | 314-432-1111
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Fax | 314-432-6308
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Provider Business Mailing Address
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Address Line | PO BOX 778969
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 314-432-1111
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Fax | 314-432-6308
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MINDY D POWELL
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Credential |
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Telephone | 314-983-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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