| St. Gabriel Clinic | |
|
6113 Ridge Ave Saint Louis MO 63133 | |
| (720) 235-6443 | |
| Not Available |
| Full Name | St. Gabriel Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 6113 Ridge Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Daniel Desta Bekele (MEDICAL DIRCTOR) |
| Authorized Official Contact | 3142309050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Gabriel Clinic 6113 Ridge Ave Saint Louis MO 63133-2616 Ph: (314) 230-9050 | St. Gabriel Clinic 6113 Ridge Ave Saint Louis MO 63133 Ph: (720) 235-6443 |
| NPI Number | 1326524604 |
|---|---|
| Provider Enumeration Date | 07/19/2018 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 4688922354 |
|---|---|
| Medicare Enrollment ID | O20180813002033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326524604 | NPI | - | NPPES |
| 830059014 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Missouri) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (Missouri) | Primary |
| Provider Name | Daniel D Bekele |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1447762919 PECOS PAC ID: 8628337193 Enrollment ID: I20180109003083 |
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