Organization
ST ANTHONY'S PHYSICIAN ORGANIZATION SPECIALTY SERVICES LLC
Active
Other names
St. Anthony's Long Term Care Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MORTON MD (CMO)
(314) 525-1153
Entity
Organization
Contact information
Practice address
12700 SOUTHFORK RD, SUITE 105, SAINT LOUIS, MO 63128-3201
(314) 525-1887
(314) 525-1868
Mailing address
12700 SOUTHFORK RD, SUITE 105, SAINT LOUIS, MO 63128-3201
(314) 525-1887
(314) 525-1868
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA3809
MEDICARE PTAN
MO
01
—
MA3810
MEDICARE PTAN
MO
Enumeration date
05/04/2011
Last updated
10/12/2016
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