Provider Demographics
NPI:1578037131
Name:STL BARIATRICS LP
Entity Type:Organization
Organization Name:STL BARIATRICS LP
Other - Org Name:ST LOUIS BARIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-366-4874
Mailing Address - Street 1:PO BOX 270419
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-366-4874
Mailing Address - Fax:314-366-4875
Practice Address - Street 1:10296 BIG BEND RD STE 206
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6582
Practice Address - Country:US
Practice Address - Phone:314-366-4874
Practice Address - Fax:314-366-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty