St. Anthony'S Physician Organization

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

ST. ANTHONY'S PHYSICIAN ORGANIZATION

Practice address

714 Gravois Rd
Ste 115
Fenton, MO 63026-7723

Phone

(636) 717-6775

Fax

(636) 717-6755

NPI assigned

Sep 26, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Cheryl Matejka

Title

Cfo East Communities & Sfo

Phone

(314) 251-1958

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mercy Clinic South Physicians Doing business as

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

{
    "created_epoch": "1411689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1144623786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD STE 115",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267723",
            "telephone_number": "636-717-6775",
            "fax_number": "636-717-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "STE 115",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267723",
            "telephone_number": "636-717-6775",
            "fax_number": "636-717-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ANTHONY'S PHYSICIAN ORGANIZATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-26",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "MATEJKA",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "CFO EAST COMMUNITIES & SFO",
        "authorized_official_telephone_number": "314-251-1958",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000015644",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic South Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Fenton, MO
• Obstetrics & Gynecology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; 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.