# ST. LOUIS BREAST CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043512999
- **Authorized official:** MR. RICHARD MUCKERMAN III M.D. (PRESIDENT)
- **Authorized official phone:** (314) 409-2108

## Contact information

- **Practice address:** 884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
- **Practice address phone:** (636) 779-8008
- **Mailing address:** 884 WOODS MILL RD, SUITE 203, BALLWIN, MO 63011-3657
- **Mailing address phone:** (636) 779-8008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0206X | Mammography Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 11/29/2010
- **Last updated:** 11/29/2010