Provider Demographics
NPI:1891015632
Name:BREAST CARE CENTER AT ST. LUKE'S, LLC
Entity Type:Organization
Organization Name:BREAST CARE CENTER AT ST. LUKE'S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-685-7804
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-205-6491
Mailing Address - Fax:314-205-6492
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:STE 200 E
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6491
Practice Address - Fax:314-205-6492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S EPISCOPAL PRESBYTERIAN HOSPTIALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891015632Medicaid
MOMA2576Medicare PIN