MEDICARE: METRO HEART GROUP OF ST. LOUIS, INC.

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	174400000X	Specialist		MO

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

General Provider Information

NPI Number	:	1487650545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO HEART GROUP OF ST. LOUIS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 66754
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63166-6754
Country	:	US
Telephone Number	:	314-880-6100
Fax Number	:	314-997-3248

Provider Business Practice Location Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 3300
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-931-6302
Fax Number	:	636-933-3609

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROCK EREKSON
Credential	:
Telephone Number	:	314-880-6107

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/21/2022

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