Basic Information
| Provider Information | |||||||||
| NPI: | 1093860652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAY | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4352 MANCHESTER AVE | ||||||||
| Address2: | FAMILY CARE HEALTH CENTER, FOREST PARK SOUTHEAST | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631102138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145315444 | ||||||||
| FaxNumber: | 3145310063 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 HOLLY HILLS AVE | ||||||||
| Address2: | FAMILY CARE HEALTH CENTER ADMINISTRATION | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631112410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144811615 | ||||||||
| FaxNumber: | 3143531310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A64950 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200702054 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A649500 | 05 | CA | MEDICAID | 207543000 | 05 | MO | MEDICAID |