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General NPI Number Information
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NPI Number | 1265392476
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Entity Type | Organization
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Legal Business Name | UROLOGY OF ST. LOUIS, INC.
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 3 SAINT ELIZABETH BLVD STE 3900
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City | O FALLON
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State | IL
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Zip | 62269-1282
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Country | US
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Telephone | 314-806-1770
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Fax | 314-558-9017
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR STE 375
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-567-6071
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Fax | 314-453-9965
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ANGIE SMITH
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Credential |
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Telephone | 314-336-5062
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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 |
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License Number State |
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