Provider Demographics
NPI:1922010826
Name:STORK OBSTETRICS & GYNECOLOGY INC
Entity Type:Organization
Organization Name:STORK OBSTETRICS & GYNECOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-525-4100
Mailing Address - Street 1:PO BOX 771244
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-2244
Mailing Address - Country:US
Mailing Address - Phone:314-555-4100
Mailing Address - Fax:314-525-4891
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 230A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-555-4100
Practice Address - Fax:314-525-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG0719OtherMEDICARE RAILROAD
MODG0719OtherMEDICARE RAILROAD