Provider Demographics
NPI:1023017746
Name:SA HOSPITAL ACQUISITION GROUP, LLC
Entity Type:Organization
Organization Name:SA HOSPITAL ACQUISITION GROUP, LLC
Other - Org Name:SOUTH CITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFILIPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-865-7917
Mailing Address - Street 1:3933 SOUTH BROADWAY STREET
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4601
Mailing Address - Country:US
Mailing Address - Phone:314-865-7902
Mailing Address - Fax:314-865-7938
Practice Address - Street 1:3933 SOUTH BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4601
Practice Address - Country:US
Practice Address - Phone:314-865-7902
Practice Address - Fax:314-865-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO512-1273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010635001Medicaid
26S210Medicare Oscar/Certification