Provider Demographics
NPI:1225134117
Name:WILLIAM R REILLY INC
Entity Type:Organization
Organization Name:WILLIAM R REILLY INC
Other - Org Name:ST. LOUIS CARDIOVASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-939-4200
Mailing Address - Street 1:PO BOX 78399
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63178-8399
Mailing Address - Country:US
Mailing Address - Phone:618-939-4200
Mailing Address - Fax:618-939-4256
Practice Address - Street 1:450 N. NEW BALLAS RD
Practice Address - Street 2:STE 170W
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:618-939-4200
Practice Address - Fax:618-939-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2F41207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20248037Medicaid
MO990001262Medicare ID - Type Unspecified
IL625930Medicare PIN
MO20248037Medicaid
IL329405361Medicare ID - Type Unspecified
IL775370Medicare ID - Type Unspecified
MO000085223Medicare PIN
S76951Medicare UPIN