Provider Demographics
NPI:1407886385
Name:DES PERES HOSPITAL, INC.
Entity Type:Organization
Organization Name:DES PERES HOSPITAL, INC.
Other - Org Name:DES PERES HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 741263
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1263
Mailing Address - Country:US
Mailing Address - Phone:678-242-2002
Mailing Address - Fax:314-966-9274
Practice Address - Street 1:2345 DOUGHERTY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3313
Practice Address - Country:US
Practice Address - Phone:314-966-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO437-8282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
430OtherBC ALLIANCE
51OtherBC CHOICE
1016028OtherCARE PARTNERS BHP
812778650OtherAETNA US HEALTHCARE (NATI
000440OtherHUMANA
269304OtherHEALTHLINK
430OtherBCBS OF MISSOURI
260176OtherMC UNITY MENTAL HLTH
10491207OtherMCAID COMMUNITY CARE
MO010491207Medicaid
27188OtherCMR CARPENTERS
6316940OtherAETNA
5020283OtherGENCARE PPO
=========OtherMCAID PRUD HEALTH
430OtherBCBS OF MISSOURI
26-0176Medicare Oscar/Certification