Provider Demographics
NPI:1346579281
Name:ADVANCED ICU CARE
Entity Type:Organization
Organization Name:ADVANCED ICU CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. MEDICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-514-6000
Mailing Address - Street 1:16444 WESTKNOLL CV
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4668
Mailing Address - Country:US
Mailing Address - Phone:414-331-0089
Mailing Address - Fax:
Practice Address - Street 1:999 EXECUTIVE PARKWAY DR
Practice Address - Street 2:STE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6336
Practice Address - Country:US
Practice Address - Phone:314-514-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2009009197363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty