MEDICARE: JACK SAILOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	P059173009	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P059173009	OTHER	MO	CERTIFIED ATHLETIC TRAINER

General Provider Information

NPI Number	:	1033513692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK SAILOR

Provider Business Mailing Address
First Line	:	2206 LUCAS AVE UNIT 508
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1555
Country	:	US
Telephone Number	:	314-307-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 LUCAS AVE UNIT 508
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1555
Country	:	US
Telephone Number	:	314-307-4197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

Similar Medicare Providers

1780476499 — JEFFREY THOMAS ADKISSON JR.
Practice Location Address:

1555 FOXLEIGH CT
SAINT LOUIS, MO
63131-1229

Practice Phone: 314-917-1738
Practice Fax:

1457208316 — ALMA ASTRID DUARTE ERAZO
Practice Location Address:

1555 FOXLEIGH CT
SAINT LOUIS, MO
63131-1229

Practice Phone: 512-635-5069
Practice Fax:

1215487590 — MARIE BONNER-HORON
Practice Location Address:

1555 KISKER RD
SAINT PETERS, MO
63304-0602

Practice Phone: 636-344-0580
Practice Fax: 636-206-2486

1093483109 — WAYS OF PLAY COUNSELING SERVICES
Practice Location Address:

1555 KISKER RD
SAINT PETERS, MO
63304-0602

Practice Phone: 636-344-0580
Practice Fax: 636-206-2486

1225078389 — SARAH E MEISINGER MSW, LICSW
Practice Location Address:

1555 NORTHWAY DR
SAINT CLOUD, MN
56303-4555

Practice Phone: 320-251-1775
Practice Fax:

1881696490 — CENTRACARE CLINIC
Practice Location Address:

1555 NORTHWAY DR STE 100
SAINT CLOUD, MN
56303-1258

Practice Phone: 320-251-1775
Practice Fax: 320-240-3131

Directions to “ JACK SAILOR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.