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
1	207Q00000X	Family 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

General Provider Information

NPI Number	:	1811940489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANTHONY'S PHYSICIAN ORGANIZATION

Provider Business Mailing Address
First Line	:	2900 LEMAY FERRY RD
Second Line	:	SUITE 216
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3900
Country	:	US
Telephone Number	:	314-543-5988
Fax Number	:	314-416-8547

Provider Business Practice Location Address
First Line	:	2900 LEMAY FERRY RD
Second Line	:	SUITE 216
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3900
Country	:	US
Telephone Number	:	314-543-5988
Fax Number	:	314-416-8547

Authorized Official
Title or Position	:	CFO EAST COMMUNITIES & SFO
Name	:	MS. CHERYL MATEJKA
Credential	:
Telephone Number	:	314-251-1958

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/04/2019

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