Provider Demographics
NPI:1285848275
Name:EXABLATE OF ST LOUIS, LLC
Entity Type:Organization
Organization Name:EXABLATE OF ST LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARRE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-820-7900
Mailing Address - Street 1:17300 N OUTER 40
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:630-537-3671
Mailing Address - Fax:
Practice Address - Street 1:17300 N OUTER 40
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:630-537-3671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center