Provider Demographics
NPI:1083734370
Name:FLORSSANT COUNTY OB-GYN
Entity Type:Organization
Organization Name:FLORSSANT COUNTY OB-GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJANASATHIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-839-4500
Mailing Address - Street 1:1224 GRAHAM RD STE 1113
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-839-4500
Mailing Address - Fax:
Practice Address - Street 1:1224 GRAHAM RD STE 1113
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-839-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18471OtherBLUE SHIELD
MO18471OtherBLUE SHIELD
A09932Medicare UPIN