| Roth Clinic (dba) | |
|
734 W Port Plz Dr. Suite 273 Saint Louis MO 63146-3000 | |
| (314) 227-0124 | |
| Not Available |
| Full Name | Roth Clinic (dba) |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 734 W Port Plz Dr., Saint Louis, Missouri |
| Authorized Official Name and Position | Lia Angelica Roth (PRESIDENT) |
| Authorized Official Contact | 3142270124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roth Clinic (dba) 734 W Port Plz Dr. Suite 273 Saint Louis MO 63146-3000 Ph: (314) 227-0124 | Roth Clinic (dba) 734 W Port Plz Dr. Suite 273 Saint Louis MO 63146-3000 Ph: (314) 227-0124 |
| NPI Number | 1063764587 |
|---|---|
| Provider Enumeration Date | 10/08/2012 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063764587 | NPI | - | NPPES |
| 1306164728 | Other | MO | MEDICARE NPI TYPE 1 |
| MA2277 | Other | MO | MEDICARE PTAN |
| 12086529 | Other | MO | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2009030440 (Missouri) | Primary |
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