Provider Demographics
NPI:1619985694
Name:ST.LOUIS CHINESE COMMUNITY SERVICE CTR
Entity Type:Organization
Organization Name:ST.LOUIS CHINESE COMMUNITY SERVICE CTR
Other - Org Name:CHINESE COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIP TONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:314-989-1220
Mailing Address - Street 1:8225 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2708
Mailing Address - Country:US
Mailing Address - Phone:314-989-1200
Mailing Address - Fax:314-989-1200
Practice Address - Street 1:8225 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2708
Practice Address - Country:US
Practice Address - Phone:314-989-1220
Practice Address - Fax:314-989-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1129042083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
939274896Medicare ID - Type Unspecified