Provider Demographics
NPI:1629373097
Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Other - Org Name:ME'TIS BREAST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PHYSICIAN BILLING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:573-883-4472
Mailing Address - Street 1:1455 HIGHWAY 61 STE B
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4109
Mailing Address - Country:US
Mailing Address - Phone:573-883-4441
Mailing Address - Fax:573-883-4472
Practice Address - Street 1:1455 HIGHWAY 61 STE B
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4109
Practice Address - Country:US
Practice Address - Phone:573-883-4441
Practice Address - Fax:573-883-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty