MEDICARE: IPS OF ST LOUIS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1316182173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IPS OF ST LOUIS LLC

Provider Business Mailing Address
First Line	:	PO BOX 864747
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-4747
Country	:	US
Telephone Number	:	888-337-3509
Fax Number	:	941-328-3997

Provider Business Practice Location Address
First Line	:	8637 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1906
Country	:	US
Telephone Number	:	314-983-0303
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CARL R NOBACK
Credential	:	MD
Telephone Number	:	941-360-1566

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	10/06/2020

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Directions to “IPS OF ST LOUIS LLC ” Practice Location

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