Provider Demographics
NPI:1790441046
Name:COMPLEX ILLNESS MANAGEMENT OF ST LUKES LLC
Entity Type:Organization
Organization Name:COMPLEX ILLNESS MANAGEMENT OF ST LUKES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-685-7804
Mailing Address - Street 1:121 SAINT LUKES CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3518
Mailing Address - Country:US
Mailing Address - Phone:636-685-7804
Mailing Address - Fax:314-576-2344
Practice Address - Street 1:224 S WOODS MILL RD STE 620S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3619
Practice Address - Country:US
Practice Address - Phone:636-685-7786
Practice Address - Fax:314-205-6377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKES MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty