Endoscopy Center of St. Louis
Organization Active NPI Endoscopy Clinic/Center · Lake Saint Louis, MO
NPI 1023094836 · NPPES record last updated Nov 27, 2007
Key facts
- NPI
- 1023094836
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Endoscopy Clinic/Center 261QE0800X
- License
- 152-0 (MO)
- Legal business name
- ENDOSCOPY CENTER OF ST. LOUIS
- Practice address
- 200 Brevco Plaza
Suite 207
Lake Saint Louis, MO 63367 - Phone
- (636) 561-5450
- Fax
- (636) 561-5451
- NPI assigned
- Dec 22, 2005
- Organization subpart
- No
Authorized official
- Name
- James H. Petersen, M.D.
- Title
- President
- Phone
- (636) 561-5450
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D1032414 | Mercy Hospital Endoscopy Center Lake St Louis | Certificate of waiver | Oct 21, 2026 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endoscopy Clinic/Center | 261QE0800X | 152-0 | MO | Yes |
Addresses
Primary practice location
200 Brevco Plaza
Suite 207
Lake Saint Louis, MO 63367
Mailing address
200 Brevco PLZ
Suite 207
Lake Saint Louis, MO 63367-2947
Phone (636) 561-5450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00214935 | Other | MO | RAIL ROAD MEDICARE |
| 195965 | Other | MO | BCBS |
Other providers in Lake Saint Louis, MO
- Haley Anne Downs
- Andrew Drysdale
- Piotr T Dyk
- Echoes of Hope
- Emily Christine Elmendorf
- Erik Evans
- Ashley Fagan
- Richard A Felkel
- Amy Fereday
- Judy Fletcher
All providers in Lake Saint Louis, MO · Endoscopy Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.