Active NPI
St Louis Gastroenterology Consultants PC
- Gastroenterology Physician
- St Louis, MO
National Provider Identifier
1639236136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- Legal business name
- ST LOUIS GASTROENTEROLOGY CONSULTANTS PC
- Practice address
- 10012 Kennerly Rd
St Louis, MO 63128 - Phone
- (314) 543-5200
- Fax
- (314) 543-5219
- NPI assigned
- Jan 3, 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
- Mr. Timothy T Brady, MD
- Title
- President
- Phone
- (314) 543-5200
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | Primary |
Addresses
Primary practice location
10012 Kennerly Rd
St Louis, MO 63128
Mailing address
10012 Kennerly Rd
Suite 101
St Louis, MO 63128
Phone (314) 543-5200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 502449705 | Medicaid | MO |
National Provider Directory
National Provider DirectoryLocations
1011 Bowles Ave
Ste 121
Fenton, MO 63026
Phone (314) 200-2713
13303 Tesson Ferry Rd
Ste 35
Saint Louis, MO 63128
Phone (314) 842-5700
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1258416000000",
"number": "1639236136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10012 KENNERLY RD",
"address_2": "SUITE 101",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63128",
"telephone_number": "314-543-5200",
"fax_number": "314-543-5219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10012 KENNERLY RD",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63128",
"telephone_number": "314-543-5200",
"fax_number": "314-543-5219"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST LOUIS GASTROENTEROLOGY CONSULTANTS PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-03",
"last_updated": "2009-11-17",
"status": "A",
"authorized_official_last_name": "BRADY",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "314-543-5200",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Gastroenterology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "502449705",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.