Organization
EXECUTIVE NEUROPSYCHIATRIC SYSTEMS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ANNETTE MINCHIN M.D. (PRESIDENT)
(314) 367-3050
Entity
Organization
Contact information
Practice address
225 S MERAMEC AVE, SUITE 1221T, CLAYTON, MO 63105-3511
(314) 367-3050
(314) 367-3712
Mailing address
225 S MERAMEC AVE, SUITE 1221T, CLAYTON, MO 63105-3511
(314) 367-3050
(314) 367-3712
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD102146
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000095333
MEDICARE IDENTIFICATION NUMBER
MO
01
—
10853441
CAQH IDENTIFICATION NUMBER
MO
Enumeration date
12/16/2008
Last updated
07/28/2009
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