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General NPI Number Information
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NPI Number | 1588991509
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Entity Type | Organization
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Legal Business Name | ST LOUIS MEDICAL CONSULTING, PC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 108 LIME KILN RD
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City | SUFFERN
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State | NY
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Zip | 10901-2602
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Country | US
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Telephone | 917-913-9232
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LIME KILN RD
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City | SUFFERN
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State | NY
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Zip | 10901-2602
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Country | US
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Telephone | 845-476-1460
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHILDEBERT ST LOUIS
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Credential | MD
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Telephone | 845-476-1460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 250239
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License Number State | NY
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