Organization
IPS OF ST LOUIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R NOBACK MD (MEMBER)
(941) 360-1566
Entity
Organization
Contact information
Practice address
8637 DELMAR BLVD, SAINT LOUIS, MO 63124-1906
(314) 983-0303
Mailing address
PO BOX 864747, ORLANDO, FL 32886-4747
(888) 337-3509
(941) 328-3997
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/09/2008
Last updated
10/06/2020
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