MEDICARE: CITY OF ST LOUIS

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	174200000X	Meals Provider

General Provider Information

NPI Number	:	1770252090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ST LOUIS

Provider Business Mailing Address
First Line	:	1520 MARKET ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2620
Country	:	US
Telephone Number	:	314-657-1673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 MARKET ST RM 4086
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2614
Country	:	US
Telephone Number	:	314-657-1673
Fax Number	:

Authorized Official
Title or Position	:	INFORMATION SYSTEMS COORDINATOR
Name	:	ANITA JENKINS
Credential	:
Telephone Number	:	314-657-1673

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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Directions to “CITY OF ST LOUIS ” Practice Location

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