Provider Demographics
NPI:1205898574
Name:PLANNED PARENTHOOD GREAT RIVERS-MISSOURI
Entity type:Organization
Organization Name:PLANNED PARENTHOOD GREAT RIVERS-MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-828-1804
Mailing Address - Street 1:4251 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2810
Mailing Address - Country:US
Mailing Address - Phone:314-531-7526
Mailing Address - Fax:314-531-3190
Practice Address - Street 1:4251 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2810
Practice Address - Country:US
Practice Address - Phone:314-531-7526
Practice Address - Fax:314-531-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004523332900000X
MO520524208261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO520524208Medicaid
MO520524224Medicaid
MO520524216Medicaid
MO520524232Medicaid
MO520524257Medicaid
MO520524240Medicaid