Provider Demographics
NPI:1952639528
Name:ST LOUIS MEDICAL PROFESSIONALS
Entity Type:Organization
Organization Name:ST LOUIS MEDICAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEITNE
Authorized Official - Prefix:DR
Authorized Official - First Name:HANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-543-2800
Mailing Address - Street 1:8790 WATSON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5140
Mailing Address - Country:US
Mailing Address - Phone:314-543-2800
Mailing Address - Fax:314-543-2801
Practice Address - Street 1:8790 WATSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5140
Practice Address - Country:US
Practice Address - Phone:314-543-2800
Practice Address - Fax:314-543-2801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LOUIS MEDICAL PROFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507345502Medicaid
MO000013841Medicare PIN