Provider Demographics
NPI:1295869824
Name:RECTAL DIAGNOSTICS & TREATMENT CENTER
Entity type:Organization
Organization Name:RECTAL DIAGNOSTICS & TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ABBADESSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-966-7570
Mailing Address - Street 1:2315 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3313
Mailing Address - Country:US
Mailing Address - Phone:314-966-7570
Mailing Address - Fax:314-966-7788
Practice Address - Street 1:2315 DOUGHERTY FERRY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3313
Practice Address - Country:US
Practice Address - Phone:314-966-7570
Practice Address - Fax:314-966-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5J14208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA65281Medicare UPIN