Provider Demographics
NPI:1679797237
Name:SAINT LOUIS CONNECTCARE
Entity Type:Organization
Organization Name:SAINT LOUIS CONNECTCARE
Other - Org Name:ST. LOUIS CONNECTCARE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-879-6308
Mailing Address - Street 1:PO BOX 795120
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0795
Mailing Address - Country:US
Mailing Address - Phone:314-879-6308
Mailing Address - Fax:314-879-6372
Practice Address - Street 1:5535 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3005
Practice Address - Country:US
Practice Address - Phone:314-879-6308
Practice Address - Fax:314-879-6372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LOUIS CONNECTCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO199-0261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
000040110Medicare PIN