Provider Demographics
NPI:1780639088
Name:COUNTY OF ST LOUIS DIVISION OF FISCAL MANAGEMENT
Entity Type:Organization
Organization Name:COUNTY OF ST LOUIS DIVISION OF FISCAL MANAGEMENT
Other - Org Name:ST LOUIS COUNTY DEPT OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-615-6445
Mailing Address - Street 1:6121 N HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-2003
Mailing Address - Country:US
Mailing Address - Phone:314-615-0500
Mailing Address - Fax:314-615-8303
Practice Address - Street 1:6121 N HANLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2003
Practice Address - Country:US
Practice Address - Phone:314-615-0600
Practice Address - Fax:314-615-8303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LOUIS COUNTY MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8595OtherHEALTHCAREUSA - NORTH CENTRAL
MO511086308Medicaid
MO8717OtherHEALTHCARE USA SOUTH
MO8283OtherHEALTH CARE USA - JC MURPHY
MO9281OtherHEALTHCARE USA LAKESIDE
MOCC9075OtherRAILROAD MEDICARE
MO511086308Medicaid