Provider Demographics
NPI:1356476758
Name:A. C. OJASCASTRO INC.
Entity Type:Organization
Organization Name:A. C. OJASCASTRO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OJASCASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-353-2211
Mailing Address - Street 1:4130 S GRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3420
Mailing Address - Country:US
Mailing Address - Phone:314-353-2211
Mailing Address - Fax:314-353-6122
Practice Address - Street 1:4130 S GRAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3420
Practice Address - Country:US
Practice Address - Phone:314-353-2211
Practice Address - Fax:314-353-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502434202Medicaid