Organization
SPECIALIST IN GASTROENTEROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULA D WILLIS (OFFICE ADMINISTRATOR)
(314) 997-0554
Entity
Organization
Contact information
Practice address
11525 OLDE CABIN RD, CREVE COEUR, MO 63141-7146
(314) 997-0554
(314) 997-5086
Mailing address
11525 OLDE CABIN RD, CREVE COEUR, MO 63141-7146
(314) 997-0554
(314) 997-5086
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
R4F99
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012657
MEDICARE
MO
01
—
31998
GHP
—
05
—
501218002
—
MO
01
—
CG0207
RAILROAD MEDICARE
—
Enumeration date
01/12/2007
Last updated
04/25/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us