Provider Demographics
NPI:1275957169
Name:INTEGRAMED MEDICAL MISSOURI, LLC
Entity Type:Organization
Organization Name:INTEGRAMED MEDICAL MISSOURI, LLC
Other - Org Name:STL FERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-983-9000
Mailing Address - Street 1:555 N NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-983-9000
Mailing Address - Fax:
Practice Address - Street 1:555 N NEW BALLAS ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-983-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRAMED MEDICAL MISSOURI, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-12
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty