# MISSOURI BAPTIST HOSPITAL OF SULLIVAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Clair Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790953909
- **Authorized official:** RAYMOND P. DAVIDSON II MD (PRESIDENT)
- **Authorized official phone:** (314) 286-2025

## Contact information

- **Practice address:** 875 N COMMERCIAL AVE, SAINT CLAIR, MO 63077-1118
- **Practice address phone:** (636) 629-7467
- **Practice address fax:** (636) 629-7464
- **Mailing address:** 670 MASON RIDGE CENTER DR, STE. 300, SAINT LOUIS, MO 63141-8573
- **Mailing address phone:** (314) 996-7644
- **Mailing address fax:** (314) 996-7658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |

## Other

- **Enumeration date:** 02/11/2008
- **Last updated:** 02/11/2008