Provider Demographics
NPI:1013057686
Name:ST.JOSEPH HEALTH CENER WOMENS AND CHILDRENS SERVICES CLINIC
Entity type:Organization
Organization Name:ST.JOSEPH HEALTH CENER WOMENS AND CHILDRENS SERVICES CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NETWORK VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2180
Mailing Address - Street 1:300 MEDICAL PLZ STE 221
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1483
Mailing Address - Country:US
Mailing Address - Phone:636-561-2229
Mailing Address - Fax:636-625-5288
Practice Address - Street 1:300 MEDICAL PLZ STE 221
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1483
Practice Address - Country:US
Practice Address - Phone:636-561-2229
Practice Address - Fax:636-625-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty