Provider Demographics
NPI:1811200983
Name:ST LOUIS NEUROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:ST LOUIS NEUROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:314-849-5665
Mailing Address - Street 1:PO BOX 4340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-0140
Mailing Address - Country:US
Mailing Address - Phone:314-849-5665
Mailing Address - Fax:314-849-0274
Practice Address - Street 1:12810 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2913
Practice Address - Country:US
Practice Address - Phone:314-849-5665
Practice Address - Fax:314-849-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR74912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000001552Medicare PIN
MOA09976Medicare UPIN