St. Louis Center for Preventative and Longevity Medicine

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

ST. LOUIS CENTER FOR PREVENTATIVE AND LONGEVITY MEDICINE

Practice address

777 S New Ballas Rd
Suite 200E
Saint Louis, MO 63141-8705

Phone

(413) 994-1536

NPI assigned

Dec 8, 2011

Organization subpart

Yes

Parent organization

ST. LOUIS CENTER FOR PREVENTATIVE AND LONGEVITY MEDICINEAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Bligh, M.D.

Title

Medical Director

Phone

(413) 994-1536

Specialties & licenses 1

Addresses

Tax ID family

St Louis Center for Preventive and Longevity Medicine LLC2 organizations share this tax ID, including this one

Part of

St Louis Center for Preventive and Longevity Medicine LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. Louis Center of Preventitive & Longevity Medicine, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1407970288
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1033487889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 S NEW BALLAS RD",
            "address_2": "SUITE 200E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418705",
            "telephone_number": "413-994-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS CENTER FOR PREVENTATIVE AND LONGEVITY MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. LOUIS CENTER FOR PREVENTATIVE AND LONGEVITY MEDICINE",
        "enumeration_date": "2011-12-08",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "BLIGH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "413-994-1536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Louis Board of Education
• St. Louis Bone and Joint Center, LLC
• St. Louis Cancer Care, L.L.P.
• St. Louis Center for Family Development, LLC
• St. Louis Center for Family Development, LLC
• St. Louis Center for Preventive and Longevity Medicine, LLC
• St. Louis Center of Preventitive & Longevity Medicine, LLC
• St. Louis Centers for Pain Management, LLC
• St. Louis Centers for Pain Management, LLC
• St. Louis Charter School

• Non-Pharmacy Dispensing Site in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Non-Pharmacy Dispensing Site in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.