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General NPI Number Information
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NPI Number | 1609063650
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Entity Type | Organization
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Legal Business Name | ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 12700 SOUTHFORK RD STE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3201
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Country | US
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Telephone | 314-543-5285
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Fax | 314-543-5238
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Provider Business Mailing Address
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Address Line | 12700 SOUTHFORK RD STE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3201
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Country | US
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Telephone | 314-543-5285
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Fax | 314-543-5238
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | DAVE HINKLE
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Credential |
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Telephone | 314-543-5903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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