Provider Demographics
NPI:1164647657
Name:CT PARTNERS OF CHESTERFIELD, LLC
Entity Type:Organization
Organization Name:CT PARTNERS OF CHESTERFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)(MR)
Authorized Official - Phone:636-449-3990
Mailing Address - Street 1:14825 NORTH OUTER FORTY RD.
Mailing Address - Street 2:STE 110
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2026
Mailing Address - Country:US
Mailing Address - Phone:636-449-3990
Mailing Address - Fax:636-449-3997
Practice Address - Street 1:14825 NORTH OUTER FORTY RD.
Practice Address - Street 2:STE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2026
Practice Address - Country:US
Practice Address - Phone:636-449-3990
Practice Address - Fax:636-449-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0717282261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology