Provider Demographics
NPI:1336380336
Name:ST. JOHN'S MERCY PULMONARY SPECIALISTS
Entity Type:Organization
Organization Name:ST. JOHN'S MERCY PULMONARY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-364-3380
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 460-A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6590
Mailing Address - Fax:314-251-5809
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 460-A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6590
Practice Address - Fax:314-251-5809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN'S MERCY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty