Provider Demographics
NPI:1407216336
Name:ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES, L.C.
Entity Type:Organization
Organization Name:ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES, L.C.
Other - Org Name:MERCY CLINIC SOUTH HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO EAST COMMUNITIES & SFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-251-1958
Mailing Address - Street 1:9735 LANDMARK PARKWAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1646
Mailing Address - Country:US
Mailing Address - Phone:314-525-1328
Mailing Address - Fax:314-525-1378
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:3 SOUTHBRIDGE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1328
Practice Address - Fax:314-525-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3704OtherMEDICARE PTAN