MEDICARE: ST LOUIS MEDICAL PROFESSIONALS, 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	207RI0200X	Infectious Disease Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	133658	OTHER	MO	BLUE CROSS BLUE SHIELD
3	CJ3494	OTHER	MO	MEIDCARE RAILROAD
4	62328300001	OTHER	MO	DMEPTAN

General Provider Information

NPI Number	:	1396826152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LOUIS MEDICAL PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	8790 WATSON RD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5140
Country	:	US
Telephone Number	:	314-543-2800
Fax Number	:	314-543-2801

Provider Business Practice Location Address
First Line	:	8790 WATSON RD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5140
Country	:	US
Telephone Number	:	314-543-2800
Fax Number	:	314-543-2801

Authorized Official
Title or Position	:	BILLING
Name	:	NEEVEEN SALAMA
Credential	:
Telephone Number	:	314-543-2800

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/26/2024

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Directions to “ST LOUIS MEDICAL PROFESSIONALS, LLC ” Practice Location

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