Provider Demographics
NPI:1326333188
Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES
Entity Type:Organization
Organization Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES
Other - Org Name:ST LOUIS SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-5988
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-1224
Mailing Address - Fax:314-525-4957
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:STE 406
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-0000
Practice Address - Country:US
Practice Address - Phone:314-525-1224
Practice Address - Fax:314-525-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty