Provider Demographics
NPI:1467461434
Name:MISSOURI BAPTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:MISSOURI BAPTIST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-8401
Mailing Address - Street 1:3015 N BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2329
Mailing Address - Country:US
Mailing Address - Phone:314-996-5000
Mailing Address - Fax:314-996-3610
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5000
Practice Address - Fax:314-996-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103189OtherHEALTH LINK
0536913OtherAETNA HMO
MO010419307Medicaid
109OtherBLUE CROSS
5000192OtherUNITED HEALTH CARE
6350715OtherAETNA PPO
MO540419306Medicaid
260108OtherMERCY HEALTH PLANS
0536913OtherAETNA HMO
=========OtherCIGNA
5000192OtherUNITED HEALTH CARE
=========OtherTRICARE