Active NPI
St. Louis Thoracic and Vascular Inc
- Specialist
- Saint Louis, MO
National Provider Identifier
1639204696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 31077
- Legal business name
- ST. LOUIS THORACIC AND VASCULAR INC
- Practice address
- 10004 Kennerly Rd Ste 186B
Saint Louis, MO 63128-2176 - Phone
- (314) 543-5939
- Fax
- (314) 543-5954
- NPI assigned
- Feb 22, 2007
- 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
- Dr. Russell Robert Kraeger, M.D.
- Title
- Owner
- Phone
- (314) 543-5939
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 31077 | MO | Primary |
Addresses
Primary practice location
10004 Kennerly Rd Ste 186B
Saint Louis, MO 63128-2176
Mailing address
10004 Kennerly Rd
Sutie 186B
Saint Louis, MO 63128-2141
Phone (314) 543-5939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 501942809 | Medicaid | MO |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1241395200000",
"number": "1639204696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10004 KENNERLY RD",
"address_2": "SUTIE 186B",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282141",
"telephone_number": "314-543-5939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10004 KENNERLY RD STE 186B",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282176",
"telephone_number": "314-543-5939",
"fax_number": "314-543-5954"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. LOUIS THORACIC AND VASCULAR INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-22",
"last_updated": "2009-05-04",
"status": "A",
"authorized_official_last_name": "KRAEGER",
"authorized_official_first_name": "RUSSELL",
"authorized_official_middle_name": "ROBERT",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "314-543-5939",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "MO",
"license": "31077",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "501942809",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
- St. Louis Renal Care LLC. Prince Hall
- St. Louis Society for the Blind (St. Louis Society for the Blind and Visually Impaired)
- St. Louis Sports Health, LLC
- St. Louis Surgical Doctors Group, LLC
- St. Louis Therapeutic Alliance LLC
- St. Louis University
- St. Louis University (Slucare Dept of Occupational Therapy)
- St. Louis University (Slucare Dept of Internal Med Hospitalist)
- St. Louis University (SLUCare Dept of Pediatric Anesthesia)
- St. Louis University (SLUCare Department of Metabolic Screening Lab)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.