MEDICARE: ST CHARLESCODEPT OF COMMHEALTH & THE ENV

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	251K00000X	Public Health or Welfare Agency		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790849321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CHARLESCODEPT OF COMMHEALTH & THE ENV

Provider Business Mailing Address
First Line	:	1650 BOONES LICK RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2245
Country	:	US
Telephone Number	:	636-949-7400
Fax Number	:	636-949-7403

Provider Business Practice Location Address
First Line	:	1650 BOONES LICK RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2245
Country	:	US
Telephone Number	:	636-949-7400
Fax Number	:	636-949-7403

Authorized Official
Title or Position	:	ACTING DIRECTOR
Name	:	SARA EVERS
Credential	:
Telephone Number	:	636-949-7400

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	10/23/2024

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