Provider Demographics
NPI:1093092611
Name:ST LOUIS BARIATRICS LLC
Entity Type:Organization
Organization Name:ST LOUIS BARIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-366-4874
Mailing Address - Street 1:PO BOX 270419
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-366-4874
Mailing Address - Fax:314-366-4875
Practice Address - Street 1:1400 HWY 61 S
Practice Address - Street 2:SUITE G50
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:314-366-4874
Practice Address - Fax:314-366-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011030112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty