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General NPI Number Information
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NPI Number | 1477246312
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Entity Type | Organization
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Legal Business Name | ST. LOUIS VASCULAR SURGICAL SPECIALISTS PC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1300 HRC PLAZA DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1869
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Country | US
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Telephone | 314-755-1084
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Fax | 314-755-1184
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Provider Business Mailing Address
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Address Line | 1300 HRC PLAZA DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1869
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Country | US
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Telephone | 314-755-1084
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Fax | 314-755-1184
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Authorized Official
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Title or Position | CEO OWNER
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Name | DR. ROBERT IVAN HACKER
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Credential | MD
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Telephone | 314-755-1084
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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 |
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License Number State |
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