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MERCY CLINIC KIDS GI LLC NPI 1033352885


NPI Information

NPI: 1033352885
Provider Name: MERCY CLINIC KIDS GI, LLC

Former Legal Business Name: ST. JOHN'S MERCY KIDS GI, LLC

Classification: Pediatrics - 2080P0206X
Entity Type: Organization

Specialization: Pediatric Gastroenterology

CLIA Number: 26D0930423

Address:
621 S NEW BALLAS RD
SUITE 140-A
SAINT LOUIS, MO
ZIP 63141
Phone: (314) 996-0006
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MERCY CLINIC KIDS GI, LLC is a pediatric gastroenterology pediatrics in Saint Louis, MO. The provider is a pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. MERCY CLINIC KIDS GI, LLC NPI is 1033352885. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is St. John's Mercy Kids Gi, Llc.

The provider's business location address is:

621 S NEW BALLAS RD
SUITE 140-A
SAINT LOUIS, MO
ZIP 63141-232
Phone: (314) 996-0006
Fax: (314) 996-0007

The provider's authorized official is John W. Hubert .
The authorized official title is President and has the following contact phone number (314) 215-1700.

The CLIA number assigned to this NPI record is 26D0930423 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2009 and was last updated on 11/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080P0206XPediatricsPediatric GastroenterologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1509292504MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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