Provider Demographics
NPI:1275247363
Name:ARDENT HEALTH STL LLC
Entity Type:Organization
Organization Name:ARDENT HEALTH STL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:314-772-4325
Mailing Address - Street 1:2006 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3717
Mailing Address - Country:US
Mailing Address - Phone:314-772-4325
Mailing Address - Fax:
Practice Address - Street 1:2006 S 39TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3717
Practice Address - Country:US
Practice Address - Phone:314-772-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty