Provider Demographics
NPI:1013935816
Name:ST. LOUIS HEART INSTITUTE CARDIOTHORACIC SURGEONS, INC.
Entity Type:Organization
Organization Name:ST. LOUIS HEART INSTITUTE CARDIOTHORACIC SURGEONS, INC.
Other - Org Name:ST. LOUIS HEART INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-909-0747
Mailing Address - Street 1:4800 MEXICO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:314-909-0747
Mailing Address - Fax:844-535-9135
Practice Address - Street 1:4800 MEXICO RD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:314-909-0747
Practice Address - Fax:844-535-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5C872086S0129X, 208G00000X
MOR1A72208G00000X
MO2003015803208G00000X
MO20060105803208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942234331OtherNPI GORDON KNIGHT
MO242527208Medicaid
MO1013935816OtherNPI GROUP
MO990000841OtherPTAN
MO990000841OtherPTAN
MO1942234331OtherNPI GORDON KNIGHT
MO201967320Medicaid
MO001000841Medicare ID - Type UnspecifiedTED GARRETT