Provider Demographics
NPI:1114498698
Name:ST. KOLBE-PUCKETT CENTER FOR HEALING INC
Entity Type:Organization
Organization Name:ST. KOLBE-PUCKETT CENTER FOR HEALING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:THALASINOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-259-5318
Mailing Address - Street 1:970 TARA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-3654
Mailing Address - Country:US
Mailing Address - Phone:314-398-5167
Mailing Address - Fax:
Practice Address - Street 1:210 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-1906
Practice Address - Country:US
Practice Address - Phone:816-259-5318
Practice Address - Fax:816-259-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty