Desilva Medical Services LLC

Primary specialty

Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X

License

R9845 Issued in MO

Legal business name

DESILVA MEDICAL SERVICES LLC

Practice address

6308 Hazelwest CT
Suite 200
Hazelwood, MO 63042-1739

Phone

(314) 731-5555

Fax

(314) 731-5558

NPI assigned

Mar 13, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ananda Desilva, M.D.

Title

Physician Owner

Phone

(314) 731-5555

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184757072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 HAZELWEST CT",
            "address_2": "SUITE 200",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421739",
            "telephone_number": "314-731-5555",
            "fax_number": "314-731-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 HAZELWEST CT",
            "address_2": "SUITE 200",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421739",
            "telephone_number": "314-731-5555",
            "fax_number": "314-731-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESILVA MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESILVA",
        "authorized_official_first_name": "ANANDA",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "314-731-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "MO",
            "license": "R9845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent Medicine (Internal Medicine) Physician in Hazelwood, MO
• Providers in Hazelwood, MO by specialty
• Adolescent Medicine (Internal Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.