Provider Demographics
NPI:1184653800
Name:CENTRAL WEST END INTERNAL MEDICINE P.C.
Entity Type:Organization
Organization Name:CENTRAL WEST END INTERNAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT -THREATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-361-9070
Mailing Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Mailing Address - Street 2:SUITE 16305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1003
Mailing Address - Country:US
Mailing Address - Phone:314-361-9070
Mailing Address - Fax:314-361-9072
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:SUITE 16305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-361-9070
Practice Address - Fax:314-361-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109362261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF93617Medicare UPIN