Basic Information
Provider Information | |||||||||
NPI: | 1598709073 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHRISTOPHER | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | THERESE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: | IV | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 121 SAINT LUKES CENTER DR | ||||||||
Address2: | STE 403 | ||||||||
City: | CHESTERFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 630173509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3142056149 | ||||||||
FaxNumber: | 3145762350 | ||||||||
Practice Location | |||||||||
Address1: | 121 SAINT LUKES CENTER DR | ||||||||
Address2: | STE 403 | ||||||||
City: | CHESTERFIELD | ||||||||
State: | MO | ||||||||
PostalCode: | 630173509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3142056149 | ||||||||
FaxNumber: | 3145762350 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2006 | ||||||||
LastUpdateDate: | 08/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 2006026937 | MO | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | P00447925 | 01 | MO | RR MEDICARE | OTHER |