=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861252041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD GREAT RIVERS-ILLINOIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2024
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 SALEM PL
-----------------------------------------------------
City | FAIRVIEW HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62208-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-531-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4251 FOREST PARK AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-531-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | MR. THOMAS JAMES WOHLFEIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-482-0097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------