Provider Demographics
NPI:1295824092
Name:THE MS CENTER OF SAINT LOUIS
Entity Type:Organization
Organization Name:THE MS CENTER OF SAINT LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOERLE-JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-893-1256
Mailing Address - Street 1:1176 TOWN AND COUNTRY COMMONS
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8200
Mailing Address - Country:US
Mailing Address - Phone:636-893-1260
Mailing Address - Fax:636-893-1261
Practice Address - Street 1:1176 TOWN AND COUNTRY COMMONS
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8200
Practice Address - Country:US
Practice Address - Phone:636-893-1260
Practice Address - Fax:636-893-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1G29174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014138Medicare ID - Type Unspecified