Active NPI
Roth Clinic (Dba)
- Community/Behavioral Health Agency
- Saint Louis, MO
National Provider Identifier
1063764587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 2009030440
- Legal business name
- ROTH CLINIC (DBA)
- Practice address
- 734 W Port PLZ Dr.
Suite 273
Saint Louis, MO 63146-3000 - Phone
- (314) 227-0124
- NPI assigned
- Oct 8, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Lia Angelica Roth, LCSW
- Title
- President
- Phone
- (314) 227-0124
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 2009030440 | MO | Primary |
Addresses
Primary practice location
734 W Port PLZ Dr.
Suite 273
Saint Louis, MO 63146-3000
Mailing address
734 W Port PLZ Dr.
Suite 273
Saint Louis, MO 63146-3000
Phone (314) 227-0124
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306164728 | Other | MO | MEDICARE NPI TYPE 1 |
| MA2277 | Other | MO | MEDICARE PTAN |
| 12086529 | Other | MO | CAQH |
National Provider Directory
National Provider DirectoryLocations
734 West Port Plz
Ste 273
Saint Louis, MO 63146
Phone (314) 227-0124
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Saint Charles, MO
- NPI 1306164728
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349654400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1349654400000",
"number": "1063764587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "734 W PORT PLZ DR.",
"address_2": "SUITE 273",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463000",
"telephone_number": "314-227-0124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "734 W PORT PLZ DR.",
"address_2": "SUITE 273",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463000",
"telephone_number": "314-227-0124"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROTH CLINIC (DBA)",
"organizational_subpart": "NO",
"enumeration_date": "2012-10-08",
"last_updated": "2012-10-08",
"status": "A",
"authorized_official_last_name": "ROTH",
"authorized_official_first_name": "LIA",
"authorized_official_middle_name": "ANGELICA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "314-227-0124",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "MO",
"license": "2009030440",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NPI TYPE 1",
"identifier": "1306164728",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "MA2277",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "12086529",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.