Provider Demographics
NPI:1811028608
Name:ST.LOUIS PEDIATRIC PRACTITIONERS,INC.
Entity Type:Organization
Organization Name:ST.LOUIS PEDIATRIC PRACTITIONERS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-261-5250
Mailing Address - Street 1:3737 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1736
Mailing Address - Country:US
Mailing Address - Phone:314-261-5250
Mailing Address - Fax:314-261-4567
Practice Address - Street 1:3737 N KINGSHIGHWAY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1736
Practice Address - Country:US
Practice Address - Phone:314-261-5250
Practice Address - Fax:314-261-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty