Provider Demographics
NPI:1063484434
Name:MARK A.SCHEPERLE, INC.
Entity Type:Organization
Organization Name:MARK A.SCHEPERLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHEPERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-862-7711
Mailing Address - Street 1:1520 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1407
Mailing Address - Country:US
Mailing Address - Phone:314-862-7711
Mailing Address - Fax:314-862-7879
Practice Address - Street 1:1520 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1407
Practice Address - Country:US
Practice Address - Phone:314-862-7711
Practice Address - Fax:314-862-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101625207R00000X
MOF22892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF22892Medicare UPIN
MOG01131Medicare UPIN