MEDICARE: MODERN VASCULAR OF ST LOUIS LLC

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	2471V0106X	Vascular-Interventional Technology Radiologic Technologist
2	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1972106391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN VASCULAR OF ST LOUIS LLC

Provider Business Mailing Address
First Line	:	26500 AGOURA RD STE 102-587
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1952
Country	:	US
Telephone Number	:	818-880-8605
Fax Number	:	818-579-7916

Provider Business Practice Location Address
First Line	:	641 N NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6713
Country	:	US
Telephone Number	:	314-648-0101
Fax Number	:	314-899-2715

Authorized Official
Title or Position	:	CEO
Name	:	YURY GAMPEL
Credential	:
Telephone Number	:	818-880-8605

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

Similar Medicare Providers

1558240960 — STL INTERVENTIONAL ONCOLOGY INTERVENTIONAL RADIOLOGY CLINICS LLC
Practice Location Address:

641 N NEW BALLAS RD
CREVE COEUR, MO
63141-6713

Practice Phone: 314-785-4647
Practice Fax:

1982891271 — KIRUBAHARA VAHEESAN MD
Practice Location Address:

641 N NEW BALLAS RD
CREVE COEUR, MO
63141-6713

Practice Phone: 314-888-4647
Practice Fax:

1568504009 — MRS. BARBARA SUE BAER BS EDUCATION
Practice Location Address:

641 N NEW BALLAS RD
CREVE COEUR, MO
63141-6713

Practice Phone: 314-872-3345
Practice Fax: 314-872-3180

1194917773 — SPECIALTY PHARMACY OF ST. LOUIS, LLC
Practice Location Address:

623 N NEW BALLAS RD
CREVE COEUR, MO
63141-6713

Practice Phone: 314-991-5200
Practice Fax: 314-991-5210

1265929459 — REPRODUCTIVE MEDICAL ASSOCIATES OF ST LOUIS
Practice Location Address:

641 N NEW BALLAS RD
CREVE COEUR, MO
63141-6713

Practice Phone: 314-312-2878
Practice Fax:

1558362384 — DR. GRETCHEN ANNE MEYER M.D.
Practice Location Address:

641 N NEW BALLAS RD
SAINT LOUIS, MO
63141-6713

Practice Phone: 314-872-3345
Practice Fax: 314-872-3180

Directions to “MODERN VASCULAR OF ST LOUIS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.