Provider Demographics
NPI:1144399338
Name:MERCY CLINIC CHILDREN'S HEART CENTER, LLC
Entity Type:Organization
Organization Name:MERCY CLINIC CHILDREN'S HEART CENTER, LLC
Other - Org Name:MERCY CHILDRENS HEART CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARAMITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-1952
Mailing Address - Street 1:621 S NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 198-A
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8255
Mailing Address - Country:US
Mailing Address - Phone:314-251-6777
Mailing Address - Fax:314-251-5859
Practice Address - Street 1:621 S NEW BALLAS ROAD
Practice Address - Street 2:SUITE 198-A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8255
Practice Address - Country:US
Practice Address - Phone:314-251-6777
Practice Address - Fax:314-251-5859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CLINIC EAST COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500211800Medicaid