Provider Demographics
NPI:1104856442
Name:ST. LOUIS INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:ST. LOUIS INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIJ
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-543-2222
Mailing Address - Street 1:5000 CEDAR PLAZA PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3441
Mailing Address - Country:US
Mailing Address - Phone:314-647-9797
Mailing Address - Fax:314-270-8520
Practice Address - Street 1:5000 CEDAR PLAZA PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3891
Practice Address - Country:US
Practice Address - Phone:314-647-9797
Practice Address - Fax:314-270-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505083808Medicaid
MO81878OtherGROUP HEALTH PLAN
MO5746972OtherCIGNA
MO000013436Medicare PIN
MO81878OtherGROUP HEALTH PLAN