St. Louis Center of Preventitive & Longevity Medicine, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD102881 Issued in MO

Legal business name

ST. LOUIS CENTER OF PREVENTITIVE & LONGEVITY MEDICINE, LLC

Practice address

1034 S Brentwood Blvd
Suite 1060
Saint Louis, MO 63117-1223

Phone

(314) 721-0666

Fax

(314) 727-9612

NPI assigned

Mar 19, 2007

Organization subpart

No

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

Authorized official

Name

Richard A. Bligh, MDNPI 1306813050

Title

Physician

Phone

(314) 721-0666

Specialties & licenses 1

Addresses

Tax ID family

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

Other organizations with this tax ID 1

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

• St. Louis Center for Preventative and Longevity Medicine

  • Non-Pharmacy Dispensing Site
  • Saint Louis, MO
  • NPI 1033487889
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Allan Bligh, MD

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306813050
  NPD (past) Authorized official
• Mohammad Ahmed, MD

  • Internal Medicine Physician
  • Chesterfield, MO
  • NPI 1386636447
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407970288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 LACKLAND HILL PKWY",
            "address_2": "ATTN CREDENTIALING DEPAT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463572",
            "telephone_number": "314-989-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S BRENTWOOD BLVD",
            "address_2": "SUITE 1060",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171223",
            "telephone_number": "314-721-0666",
            "fax_number": "314-727-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS CENTER OF PREVENTITIVE & LONGEVITY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLIGH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "314-721-0666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "MD102881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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 Preventative and Longevity Medicine
• St. Louis Center for Preventive and Longevity Medicine, LLC
• St. Louis Centers for Pain Management, LLC
• St. Louis Centers for Pain Management, LLC
• St. Louis Charter School
• St. Louis Charter School
• St. Louis Child Neurology Services, P.C.

• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• 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.