| St. Louis Center For Preventive And Longevity Medicine, Llc | |
|
777 S New Ballas Rd Suite 200 E Saint Louis MO 63141-8705 | |
| (314) 994-1536 | |
| (314) 692-0241 |
| Full Name | St. Louis Center For Preventive And Longevity Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 777 S New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Richard Allan Bligh (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3149941536 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Louis Center For Preventive And Longevity Medicine, Llc 777 S New Ballas Rd Suite 200 E Saint Louis MO 63141-8705 Ph: (314) 994-1536 | St. Louis Center For Preventive And Longevity Medicine, Llc 777 S New Ballas Rd Suite 200 E Saint Louis MO 63141-8705 Ph: (314) 994-1536 |
| NPI Number | 1003027988 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 12/27/2007 |
| Medicare PECOS PAC ID | 7618058868 |
|---|---|
| Medicare Enrollment ID | O20080115000059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003027988 | NPI | - | NPPES |
| 1306813050 | Other | MO | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 102881 (Missouri) | Primary |
| Provider Name | Richard A Bligh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306813050 PECOS PAC ID: 4981785136 Enrollment ID: I20080115000054 |
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