Organization
MIDWEST CARDIOVASCULAR CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROCK EREKSON (SECRETARY/TREASURER)
(314) 997-4622
Entity
Organization
Contact information
Practice address
10012 KENNERLY RD, SUITE 203, SAINT LOUIS, MO 63128-2197
(314) 842-9070
(314) 842-9952
Mailing address
11475 OLDE CABIN RD, SUITE 200, SAINT LOUIS, MO 63141-7128
(314) 997-4622
(314) 997-3248
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103800
HEALTHLINK
MO
01
—
123517
BC/BS
MO
01
—
3400001
UHC
MO
01
—
3749601-001
CIGNA
MO
01
—
7326100
AETNA
MO
Enumeration date
02/13/2006
Last updated
08/22/2020
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