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General NPI Number Information
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NPI Number | 1487650545
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Entity Type | Organization
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Legal Business Name | METRO HEART GROUP OF ST. LOUIS, INC.
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1390 HIGHWAY 61 SUITE 3300
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-931-6302
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Fax | 636-933-3609
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Provider Business Mailing Address
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Address Line | PO BOX 66754
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City | SAINT LOUIS
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State | MO
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Zip | 63166-6754
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Country | US
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Telephone | 314-880-6100
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Fax | 314-997-3248
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROCK EREKSON
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Credential |
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Telephone | 314-880-6107
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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 | MO
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