Provider Demographics
NPI:1083930754
Name:ANSTEY INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ANSTEY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANSTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-1964
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:STE 215B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-1964
Mailing Address - Fax:314-645-3345
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:STE 215B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-432-1964
Practice Address - Fax:314-645-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD104521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty