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NPI Code Detail

MEDICARE: ST MARY'S HEALTH CENTER

MEDICARE: ST MARY'S HEALTH CENTER
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
1207R00000XInternal Medicine Physician2009006291MO

General Provider Information

NPI Number : 1992934012
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST MARY'S HEALTH CENTER
Provider Business Mailing Address
First Line : 4571 GIBSON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-1519
Country : US
Telephone Number : 314-534-6303
Fax Number :
Provider Business Practice Location Address
First Line : 6420 CLAYTON RD
Second Line : ST MARY'S HEALTH CENTER
City : SAINT LOUIS
State : MO
Zip : 63117-1811
Country : US
Telephone Number : 314-768-8778
Fax Number :
Authorized Official
Title or Position : PROGRAM DIRECTOR INTERNAL MEDICINE
Name : MOREY GARDNER
Credential :
Telephone Number : 314-768-8778
Provider Enumeration Date : 07/10/2009
Last Update Date : 07/10/2009

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Directions to “ST MARY'S HEALTH CENTER ” Practice Location

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