Provider Demographics
NPI:1821620832
Name:CYGNUS OF ST. LOUIS, LLC
Entity Type:Organization
Organization Name:CYGNUS OF ST. LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TINDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-854-4240
Mailing Address - Street 1:10430 TINDALL RD
Mailing Address - Street 2:
Mailing Address - City:CADET
Mailing Address - State:MO
Mailing Address - Zip Code:63630-8283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10430 TINDALL RD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-8283
Practice Address - Country:US
Practice Address - Phone:903-280-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management