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NPI Code Detail

MEDICARE: ST. ANTHONY'S PHYSICIAN ORGANIZATION

MEDICARE: ST. ANTHONY'S PHYSICIAN ORGANIZATION
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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000015649OTHERMOMEDICARE PTAN

General Provider Information

NPI Number : 1336469261
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. ANTHONY'S PHYSICIAN ORGANIZATION
Provider Business Mailing Address
First Line : 5425 SOUTHFIELD CTR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-5984
Country : US
Telephone Number : 314-543-5258
Fax Number : 314-543-5262
Provider Business Practice Location Address
First Line : 5425 SOUTHFIELD CTR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-5984
Country : US
Telephone Number : 314-543-5258
Fax Number : 314-543-5262
Authorized Official
Title or Position : CFO EAST COMMUNITIES & SFO
Name : MS. CHERYL MATEJKA
Credential :
Telephone Number : 314-251-1958
Provider Enumeration Date : 06/02/2010
Last Update Date : 01/04/2019

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