Provider Demographics
NPI:1821280660
Name:PROBST OB/GYN SERVICES PC
Entity Type:Organization
Organization Name:PROBST OB/GYN SERVICES PC
Other - Org Name:PROBST OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOOGSTRAAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-6033
Mailing Address - Street 1:10345 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-965-6033
Mailing Address - Fax:314-965-6067
Practice Address - Street 1:10345 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1105
Practice Address - Country:US
Practice Address - Phone:314-965-6033
Practice Address - Fax:314-965-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001060Medicare PIN