Organization
ST. ANTHONY'S PHYSICIAN ORGANIZATION
Active
Other names
Mercy Clinic South Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL MATEJKA (CFO EAST COMMUNITIES & SFO)
(314) 251-1958
Entity
Organization
Contact information
Practice address
714 GRAVOIS RD, STE 115, FENTON, MO 63026-7723
(636) 717-6775
(636) 717-6755
Mailing address
714 GRAVOIS RD STE 115, FENTON, MO 63026-7723
(636) 717-6775
(636) 717-6755
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015644
MEDICARE PTAN
MO
Enumeration date
09/26/2014
Last updated
01/04/2019
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