Provider Demographics
NPI:1396210852
Name:RURAL PARISH CLINIC OF THE ARCHDIOCESE OF ST. LOUIS
Entity Type:Organization
Organization Name:RURAL PARISH CLINIC OF THE ARCHDIOCESE OF ST. LOUIS
Other - Org Name:RURAL PARISH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-979-4972
Mailing Address - Street 1:20 ARCHBISHOP MAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-792-7717
Mailing Address - Fax:314-289-8037
Practice Address - Street 1:10120 CREST ROAD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-9629
Practice Address - Country:US
Practice Address - Phone:888-870-9610
Practice Address - Fax:573-438-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty