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NPI Code Detail

MEDICARE: DR. MARY VATTEROTT HASTINGS MD

MEDICARE: DR. MARY VATTEROTT HASTINGS MD
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
1207Q00000XFamily Medicine PhysicianR8E99MO
2207Q00000XFamily Medicine PhysicianMOR8399MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1289050157OTHERMOCPIN

General Provider Information

NPI Number : 1932365665
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY VATTEROTT HASTINGS MD
Provider Business Mailing Address
First Line : 1402 S. GRAND
Second Line : DEPARTMENT OF FAMILY MEDICINE
City : ST LOUIS
State : MO
Zip : 63104
Country : US
Telephone Number : 314-977-8492
Fax Number : 314-977-5268
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line : ST LOUIS COUNTY DEPARTMENT OF HEALTH
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-5767
Fax Number : 314-615-5629
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2008
Last Update Date : 09/19/2013

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