Provider Demographics
NPI:1881722700
Name:ST LOUIS PEDIATRIC ASSOCIATES, INC
Entity type:Organization
Organization Name:ST LOUIS PEDIATRIC ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-576-1616
Mailing Address - Street 1:226 S WOODS MILL RD
Mailing Address - Street 2:STE 32W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-576-1616
Mailing Address - Fax:314-576-5271
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:STE 32W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-576-1616
Practice Address - Fax:314-576-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty