Organization
SIGNATURE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD SACKMAN (CEO)
(314) 849-0311
Entity
Organization
Contact information
Practice address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Mailing address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207N00000X
Dermatology Physician
—
MO
207RG0100X
Gastroenterology Physician
—
MO
207T00000X
Neurological Surgery Physician
—
MO
207V00000X
Obstetrics & Gynecology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
MO
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208000000X
Pediatrics Physician
—
MO
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208600000X
Surgery Physician
—
MO
208C00000X
Colon & Rectal Surgery Physician
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3223
GROUP HEALTH PLAN
MO
01
—
377225
HEALTHLINK
MO
05
—
501357701
—
MO
01
—
7217344
AETNA
MO
01
—
CY0091
RAILROAD MEDICARE
MO
Enumeration date
05/08/2006
Last updated
08/08/2024
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