Provider Demographics
NPI:1356462493
Name:ST. JOHN'S MERCY CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:ST. JOHN'S MERCY CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-872-3345
Mailing Address - Street 1:641 N NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6713
Mailing Address - Country:US
Mailing Address - Phone:314-872-3345
Mailing Address - Fax:314-872-3180
Practice Address - Street 1:641 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6713
Practice Address - Country:US
Practice Address - Phone:314-872-3345
Practice Address - Fax:314-872-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016370282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren