NPIMap

Organization Active NPI

Carestl Health

  • Dental Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1306059654
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
519 Issued in MO
Legal business name
CARESTL HEALTH
Practice address
5471 Dr Martin Luther King Dr
St Louis, MO 63112
Phone
(314) 367-5820
Fax
(314) 367-7010
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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

Authorized official

Name
Mrs. Angela Renee Clabon, MBA
Title
Chief Executive Officer
Phone
(314) 367-5820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 519 MO Primary

Addresses

Primary practice location

5471 Dr Martin Luther King Dr
St Louis, MO 63112

Mailing address

5471 Dr Martin Luther King Dr
St Louis, MO 63112-4265
Phone (314) 367-5820

Other identifiers 2

IdentifierTypeStateIssuer
26DO438768OtherMOCLIA
700622913MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
St Louis Comp Health CT23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1306059654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5471 DR MARTIN LUTHER KING DR",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631124265",
            "telephone_number": "314-367-5820",
            "fax_number": "314-367-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5471 DR MARTIN LUTHER KING DR",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63112",
            "telephone_number": "314-367-5820",
            "fax_number": "314-367-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESTL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "CLABON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "314-367-5820",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26DO438768",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "700622913",
            "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 Jun 7, 2018; 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.