Organization
DR. GENOVA, LLC
Active
Parent organization
ST. LUKE'S MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. LUKE'S MEDICAL GROUP
Authorized official
JAMES SNIDER (VP PHYSICIAN NETWORK)
(636) 685-7804
Entity
Organization
Contact information
Practice address
5551 WINGHAVEN BLVD STE 250, O FALLON, MO 63368-3630
(636) 695-2520
(314) 590-5925
Mailing address
232 S WOODS MILL RD, CHESTERFIELD, MO 63017-3406
(366) 685-7804
(314) 576-2433
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD8375
RR MEDICARE
MO
Enumeration date
02/16/2007
Last updated
04/06/2021
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