Provider Demographics
NPI:1861470734
Name:ST LOUIS PET CENTERS, LLC
Entity Type:Organization
Organization Name:ST LOUIS PET CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-628-1300
Mailing Address - Street 1:12637 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6313
Mailing Address - Country:US
Mailing Address - Phone:314-628-1300
Mailing Address - Fax:314-628-1301
Practice Address - Street 1:12637 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6313
Practice Address - Country:US
Practice Address - Phone:314-628-1300
Practice Address - Fax:314-628-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
183981OtherBCBS MO
889182OtherMERCY CARE PLUS
276582OtherUSA MCO
7995486OtherAETNA
532846OtherHEALTHLINK
=========OtherMERCY
532846OtherHEALTHLINK
889182OtherMERCY CARE PLUS
=========OtherGREAT WEST