Provider Demographics
NPI:1033180526
Name:VAMC ST. LOUIS MO
Entity Type:Organization
Organization Name:VAMC ST. LOUIS MO
Other - Org Name:131ST MEDICAL GROUP MO ANG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHO PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALEXANDER-LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:314-652-4100
Mailing Address - Street 1:1424 DALE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-3614
Mailing Address - Country:US
Mailing Address - Phone:618-667-0404
Mailing Address - Fax:314-289-7034
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit