Provider Demographics
NPI:1952628810
Name:ST ANTHONY'S NEUROSURGERY SERVICES, LLC
Entity Type:Organization
Organization Name:ST ANTHONY'S NEUROSURGERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-5988
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-1258
Mailing Address - Fax:314-416-0973
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-1258
Practice Address - Fax:314-416-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2572Medicare PIN