Provider Demographics
NPI:1922328442
Name:MERCY CLINIC ENDOCRINOLOGY, LLC
Entity Type:Organization
Organization Name:MERCY CLINIC ENDOCRINOLOGY, LLC
Other - Org Name:MERCY ENDOCRINOLOGY AND DIABETES MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARAMITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-1952
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 460-A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-4330
Mailing Address - Fax:314-251-4333
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 460-A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-4330
Practice Address - Fax:314-251-4333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CLINIC EAST COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-07
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2644Medicare PIN