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General NPI Number Information
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NPI Number | 1568570620
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S MERCY SUPPORT SERVICES
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 WINDING WOODS DR SUITE 112
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City | O FALLON
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State | MO
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Zip | 63366-4771
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Country | US
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Telephone | 636-379-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 300 WINDING WOODS DR SUITE 112
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City | O FALLON
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State | MO
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Zip | 63366-4771
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Country | US
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Telephone | 636-379-6600
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Fax |
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Authorized Official
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Title or Position | CMO/VICE PRESIDENT, MEDICAL AFFAIRS
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Name | PAUL F. HINTZE
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Credential | M.D.
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Telephone | 314-251-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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