Provider Demographics
NPI:1316370059
Name:PHYSICIANS OF ST ANTHONYS MEDICAL CENTER LC
Entity Type:Organization
Organization Name:PHYSICIANS OF ST ANTHONYS MEDICAL CENTER LC
Other - Org Name:MERCY CLINIC SOUTH SUPPORT SERVICE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO EAST COMMUNITIES & SFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-251-1958
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-892-6565
Mailing Address - Fax:314-892-4828
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1576
Practice Address - Country:US
Practice Address - Phone:314-892-6565
Practice Address - Fax:314-892-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty