Provider Demographics
NPI:1295963940
Name:ST. ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Entity type:Organization
Organization Name:ST. ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-5988
Mailing Address - Street 1:2900 LEMAY FERRY ROAD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3900
Mailing Address - Country:US
Mailing Address - Phone:314-543-5988
Mailing Address - Fax:314-416-8547
Practice Address - Street 1:2900 LEMAY FERRY ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-543-5988
Practice Address - Fax:314-416-8547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. ANTHONY'S PHYSICIAN ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-01
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty