MEDICARE: ADELAIDE HORCHER M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2020038745	MO
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036091523	IL

General Provider Information

NPI Number	:	1053312918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELAIDE HORCHER M.D.

Provider Business Mailing Address
First Line	:	1201 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1016
Country	:	US
Telephone Number	:	314-977-4606
Fax Number	:	314-977-7615

Provider Business Practice Location Address
First Line	:	1 GOOD SAMARITAN WAY
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2402
Country	:	US
Telephone Number	:	618-242-4600
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/22/2021

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