MEDICARE: ARDENT HEALTH STL LLC

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1275247363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDENT HEALTH STL LLC

Provider Business Mailing Address
First Line	:	2006 S 39TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3717
Country	:	US
Telephone Number	:	314-772-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 S 39TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3717
Country	:	US
Telephone Number	:	314-772-4325
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOBIAS DONAKER
Credential	:	LAC
Telephone Number	:	314-772-4325

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/12/2023

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Directions to “ARDENT HEALTH STL LLC ” Practice Location

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