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4346 Loughborough Ave Saint Louis MO 63116-2104 | |
| (314) 481-7030 | |
| (314) 481-7120 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4346 Loughborough Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Alexander Rudoi (PHYSICIAN) |
| Authorized Official Contact | 3144817030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4346 Loughborough Ave Saint Louis MO 63116-2104 Ph: (314) 481-7030 | 4346 Loughborough Ave Saint Louis MO 63116-2104 Ph: (314) 481-7030 |
| NPI Number | 1992721047 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 11/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992721047 | NPI | - | NPPES |
| DB2750 | Other | MO | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MO100186 (Missouri) | Primary |
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