Provider Demographics
NPI:1477246312
Name:ST. LOUIS VASCULAR SURGICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:ST. LOUIS VASCULAR SURGICAL SPECIALISTS PC
Other - Org Name:ST. LOUIS LIMB PRESERVATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:HACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-755-1084
Mailing Address - Street 1:1300 HRC PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1869
Mailing Address - Country:US
Mailing Address - Phone:314-755-1084
Mailing Address - Fax:314-755-1184
Practice Address - Street 1:1300 HRC PLAZA DR
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1869
Practice Address - Country:US
Practice Address - Phone:314-755-1084
Practice Address - Fax:314-755-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty