Provider Demographics
NPI:1982756771
Name:SOUTHAMPTON HEALTHCARE INC
Entity Type:Organization
Organization Name:SOUTHAMPTON HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRELUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-647-2200
Mailing Address - Street 1:PO BOX 952024
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2024
Mailing Address - Country:US
Mailing Address - Phone:314-647-2200
Mailing Address - Fax:314-647-4172
Practice Address - Street 1:2340 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2909
Practice Address - Country:US
Practice Address - Phone:314-647-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCH6460OtherRR MEDICARE