Provider Demographics
NPI:1770770729
Name:ST. ANTHONY'S PHYSICIAN ORGANIZATION
Entity type:Organization
Organization Name:ST. ANTHONY'S PHYSICIAN ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO EAST COMMUNITIES & SFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-251-1958
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:STE 115A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-543-4444
Mailing Address - Fax:314-843-8599
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:STE 115A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-543-4444
Practice Address - Fax:314-843-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015656Medicare PIN
MO000013663Medicare PIN