Basic Information
| Provider Information | |||||||||
| NPI: | 1477965721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT LUKE'S PHYSICIAN SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 504407 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631504407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169327940 | ||||||||
| FaxNumber: | 8169327957 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 WORNALL RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169320340 | ||||||||
| FaxNumber: | 8169323148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2014 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | ABERNATHY | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8169327940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2014010579 | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.