| St Louis Gastroenterology Consultants Pc | |
|
10012 Kennerly Rd St Louis MO 63128 | |
| (314) 543-5200 | |
| (314) 543-5219 |
| Full Name | St Louis Gastroenterology Consultants Pc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 10012 Kennerly Rd, St Louis, Missouri |
| Authorized Official Name and Position | Timothy T Brady (PRESIDENT) |
| Authorized Official Contact | 3145435200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Louis Gastroenterology Consultants Pc 10012 Kennerly Rd Suite 101 St Louis MO 63128 Ph: (314) 543-5200 | St Louis Gastroenterology Consultants Pc 10012 Kennerly Rd St Louis MO 63128 Ph: (314) 543-5200 |
| NPI Number | 1639236136 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 11/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639236136 | NPI | - | NPPES |
| 502449705 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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