Provider Demographics
NPI:1649628454
Name:SPHERE MEDICAL GROUP
Entity type:Organization
Organization Name:SPHERE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-436-9300
Mailing Address - Street 1:916 OLIVE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1459
Mailing Address - Country:US
Mailing Address - Phone:314-436-9300
Mailing Address - Fax:
Practice Address - Street 1:916 OLIVE ST FL 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1459
Practice Address - Country:US
Practice Address - Phone:314-436-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLC1396760OtherSTATE OF MO