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3933 South Broadway St. Louis MO 63118-4601 | |
| (314) 865-7000 | |
| (314) 865-7938 |
| Full Name | |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 3933 South Broadway, St. Louis, Missouri |
| Authorized Official Name and Position | Bianca Defilippi (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3148657917 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3933 South Broadway St. Louis MO 63118-4601 Ph: (314) 865-7000 | 3933 South Broadway St. Louis MO 63118-4601 Ph: (314) 865-7000 |
| NPI Number | 1912109919 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 03/29/2023 |
| Certification Date | 03/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912109919 | NPI | - | NPPES |
| 010635001 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | 512-1 (Missouri) | Primary |
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