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General NPI Number Information
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NPI Number | 1316128846
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Entity Type | Organization
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Legal Business Name | VASCULAR SURGERY OF ST. LOUIS P.C.
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 04/17/2009
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Provider Practice Location Address
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Address Line | 2355 DOUGHERTY FERRY RD SUITE 440
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3325
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Country | US
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Telephone | 314-614-8775
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Fax | 314-983-9559
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Provider Business Mailing Address
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Address Line | 2355 DOUGHERTY FERRY RD SUITE 440
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3325
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Country | US
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Telephone | 314-614-8775
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Fax | 314-983-9559
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Authorized Official
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Title or Position | MANAGER
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Name | MS. ANGELA RENEE CHAMBERLIN
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Credential |
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Telephone | 314-750-0935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | R7H29
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License Number State | MO
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