NPIMap

Organization Active NPI

M. Edward Mimlitz PC

  • Obstetrics & Gynecology Physician
  • St. Louis, MO
National Provider Identifier
1952715005
Registry record updated Jul 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
101836 Issued in MO
Legal business name
M. EDWARD MIMLITZ PC
Practice address
621 S. New Ballas Rd.
Suite 419-a
St. Louis, MO 63141-8259
Phone
(314) 432-8505
Fax
(314) 432-6853
NPI assigned
Jun 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2014

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

Authorized official

Name
Mr. Michael E. Mimlitz, M.D.
Title
President
Phone
(314) 432-8505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 101836 MO Primary

Addresses

Primary practice location

621 S. New Ballas Rd.
Suite 419-a
St. Louis, MO 63141-8259

Mailing address

621 S. New Ballas Rd.
Suite 419-a
St. Louis, MO 63141-8259
Phone (314) 432-8505

Other identifiers 2

IdentifierTypeStateIssuer
208179317MedicaidMO
0700441OtherMOUNITED HEALTH CARE

National Provider Directory

National Provider Directory

Locations

9979 Winghaven Blvd
Ste 206
O Fallon, MO 63368
Phone (636) 561-5291

Practitioners & affiliated clinicians

Practitioners 4

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": "1402963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1952715005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S. NEW BALLAS RD.",
            "address_2": "SUITE 419-A",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631418259",
            "telephone_number": "314-432-8505",
            "fax_number": "314-432-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S. NEW BALLAS RD.",
            "address_2": "SUITE 419-A",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631418259",
            "telephone_number": "314-432-8505",
            "fax_number": "314-432-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M. EDWARD MIMLITZ PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-17",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "MIMLITZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-432-8505",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "101836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208179317",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0700441",
            "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 Jul 2, 2014; 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.