Provider Demographics
NPI:1568570620
Name:ST. JOHN'S MERCY SUPPORT SERVICES
Entity Type:Organization
Organization Name:ST. JOHN'S MERCY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO/VICE PRESIDENT, MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HINTZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-1955
Mailing Address - Street 1:300 WINDING WOODS DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4771
Mailing Address - Country:US
Mailing Address - Phone:636-379-6600
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR
Practice Address - Street 2:SUITE 112
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4771
Practice Address - Country:US
Practice Address - Phone:636-379-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty