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General NPI Number Information
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NPI Number | 1598926917
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Entity Type | Organization
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Legal Business Name | SAINT LOUIS HEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 3394 MCKELVEY RD SUITE 104
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City | BRIDGETON
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State | MO
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Zip | 63044-2531
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Country | US
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Telephone | 314-739-5518
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Fax | 314-739-1223
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Provider Business Mailing Address
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Address Line | 3394 MCKELVEY RD SUITE 104
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City | BRIDGETON
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State | MO
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Zip | 63044-2531
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Country | US
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Telephone | 314-739-5518
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Fax | 314-739-1223
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | THOMAS EDWARD SHEPHERD
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Credential |
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Telephone | 314-739-5518
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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 |
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License Number State |
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