Provider Demographics
NPI:1528017266
Name:MISSOURI BAPTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:MISSOURI BAPTIST MEDICAL CENTER
Other - Org Name:FAMILY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:3023 N BALLAS RD
Mailing Address - Street 2:SUITE 100D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2330
Mailing Address - Country:US
Mailing Address - Phone:314-996-7501
Mailing Address - Fax:314-996-7544
Practice Address - Street 1:3023 N BALLAS RD
Practice Address - Street 2:SUITE 100D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2330
Practice Address - Country:US
Practice Address - Phone:314-996-7501
Practice Address - Fax:314-996-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
MO20001575623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO605035302Medicaid
2048366OtherPK
1019230001Medicare NSC