Provider Demographics
NPI:1053508002
Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Entity Type:Organization
Organization Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Other - Org Name:PREMIER WOMEN'S HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-5903
Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 220
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7723
Mailing Address - Country:US
Mailing Address - Phone:636-717-6777
Mailing Address - Fax:636-717-6778
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE 220
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-717-6777
Practice Address - Fax:636-717-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015655Medicare PIN