Provider Demographics
NPI:1326122854
Name:OBSTETRICAL ASSOCIATES OF ST. LOUIS, INC.
Entity Type:Organization
Organization Name:OBSTETRICAL ASSOCIATES OF ST. LOUIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-576-9797
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 750 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3470
Mailing Address - Country:US
Mailing Address - Phone:314-576-9797
Mailing Address - Fax:314-317-3040
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 750 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3470
Practice Address - Country:US
Practice Address - Phone:314-576-9797
Practice Address - Fax:314-469-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990000426Medicare ID - Type Unspecified