Provider Demographics
NPI:1801253612
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 1:1216 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1654
Mailing Address - Country:US
Mailing Address - Phone:314-525-4611
Mailing Address - Fax:314-525-4694
Practice Address - Street 1:1216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1654
Practice Address - Country:US
Practice Address - Phone:636-937-3611
Practice Address - Fax:636-931-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty