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General NPI Number Information
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NPI Number | 1184653800
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Entity Type | Organization
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Legal Business Name | CENTRAL WEST END INTERNAL MEDICINE P.C.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ SUITE 16305
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-361-9070
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Fax | 314-361-9072
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Provider Business Mailing Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ SUITE 16305
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-361-9070
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Fax | 314-361-9072
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN COLBERT -THREATS
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Credential | M.D.
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Telephone | 314-361-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 109362
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License Number State | MO
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