Provider Demographics
NPI:1679735302
Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Entity type:Organization
Organization Name:ST ANTHONY'S PHYSICIAN ORGANIZATION PRIVATE PRACTICES LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-5903
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:STE 403
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-1800
Mailing Address - Fax:
Practice Address - Street 1:12700 SOUTHFORK RD
Practice Address - Street 2:STE 255
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3201
Practice Address - Country:US
Practice Address - Phone:314-525-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty