ST. ANTHONY'S PHYSICIAN ORGANIZATION (NPI# 1558783217) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558783217 |
| Entity Type | Organization |
| Organization Name | ST. ANTHONY'S PHYSICIAN ORGANIZATION |
| Other Organization Name | MERCY CLINIC SOUTH PHYSICIANS |
| Practice Address |
714 Gravois Rd Suite 220 Fenton MO 63026-7723 |
| Practice Telephone | 6367176777 |
| Practice Fax Number | 3145251028 |
| Mailing Telephone | 6367176777 |
| Mailing Fax Number | 3145251028 |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2019-01-04 |
| Authorized Official Name | MS. CHERYL MATEJKA (CFO EAST COMMUNITIES & SFO) |
| Authorized Official Telephone | 3142511958 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MEDICARE PTAN | 000015644 | 01 |
| Other Name | Type Code |
|---|---|
| Mercy Clinic South Physicians | Doing Business As Name - Organization |
| St Anthony's Premier Women's Health Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801254164 | St. Anthony's Physician Organization | Orthopaedic Surgery | 12700 Southfork Rd Ste 100, Saint Louis, MO 63128-3201 | 2016-02-02 |
| 1124439708 | St. Anthony's Physician Organization | Assisted Living Facility | 9735 Landmark Parkway Dr Ste 200, Saint Louis, MO 63127-1666 | 2014-05-16 |
| 1992127492 | St. Anthony's Physician Organization | Psychiatry & Neurology | 10020 Kennerly Rd Fl 2, Saint Louis, MO 63128-2106 | 2014-01-17 |
| 1659793305 | St. Anthony's Physician Organization | Internal Medicine | 12700 Southfork Rd Ste 200, Saint Louis, MO 63128-3201 | 2014-01-15 |
| 1396065041 | St. Anthony's Physician Organization | Internal Medicine | 12700 Souhtfork Road, Suite 200, Saint Louis, MO 63128-2106 | 2010-06-04 |
| 1538495353 | St. Anthony's Physician Organization | Internal Medicine | 1001 S Kirkwood Rd Ste 300, Saint Louis, MO 63122-7250 | 2009-10-29 |
| 1487819512 | St. Anthony's Physician Organization | Internal Medicine | 10296 Big Bend Blvd, Suite 111, Kirkwood, MO 63122 | 2008-07-29 |
| 1871093690 | St. Anthony's Physician Organization | Internal Medicine | 10012 Kennerly Rd Ste 102, Saint Louis, MO 63128-2197 | 2018-02-19 |
| 1578917464 | St. Anthony's Physician Organization | Internal Medicine | 1001 S Kirkwood Rd, Ste 300, Saint Louis, MO 63122-7254 | 2016-04-18 |
| 1588026421 | St. Anthony's Physician Organization | Internal Medicine | 12700 Southfork Rd, Ste 200/220, Saint Louis, MO 63128-3201 | 2016-03-21 |
| Street Address |
714 GRAVOIS RD SUITE 220 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-7723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407856396 | Damon R. Broyles | Family Medicine | 714 Gravois Rd, Suite 210, Fenton, MO 63026-7727 | 2005-07-21 |
| 1619441201 | Christina Lynn Roeder | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2019-01-16 |
| 1437638764 | Stacia Smith | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2018-08-08 |
| 1093231151 | Kristin Blair Aubuchon | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2017-08-20 |
| 1962949396 | Christine Michelle Rodesiler | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2017-01-24 |
| 1003360850 | Sheila Marie Mueller | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2016-08-10 |
| 1821456112 | Mia Glover | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2016-02-02 |
| 1144623786 | St. Anthony's Physician Organization | Obstetrics & Gynecology | 714 Gravois Rd, Ste 115, Fenton, MO 63026-7723 | 2014-09-26 |
| 1508126889 | Vandana Dalton | Obstetrics & Gynecology | 714 Gravois Rd, Fenton, MO 63026-7723 | 2012-05-21 |
| 1548529050 | Tina Louise Kinney | Nurse Practitioner | 714 Gravois Rd, Fenton, MO 63026-7723 | 2012-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508328782 | Lauren Marie Rackovan | Obstetrics & Gynecology | 1011 Bowles Ave Ste 215, Fenton, MO 63026-2387 | 2019-04-04 |
| 1144798737 | Frg Rlt Holdings, Inc. | Obstetrics & Gynecology | 1747 Smizer Station Rd Ste 1, Fenton, MO 63026-2784 | 2018-11-13 |
| 1922184258 | Jack E Ricketts | Obstetrics & Gynecology | 408 Gravois, Fenton, MO 63026 | 2006-10-30 |
| 1083684468 | Adriana M Canas-polesel | Obstetrics & Gynecology | 1203 Smizer Mill Rd Ste 106, Fenton, MO 63026-3483 | 2006-01-26 |
| 1144623786 | St. Anthony's Physician Organization | Obstetrics & Gynecology | 714 Gravois Rd, Ste 115, Fenton, MO 63026-7723 | 2014-09-26 |
| 1508126889 | Vandana Dalton | Obstetrics & Gynecology | 714 Gravois Rd, Fenton, MO 63026-7723 | 2012-05-21 |
| 1659661999 | Sheila Eileen Drnec | Obstetrics & Gynecology | 1203 Smizer Mill Rd Ste 106, Fenton, MO 63026 | 2011-04-07 |
| 1508096934 | Womens Ob/gyn and Bladder Solutions Center, P.C. | Obstetrics & Gynecology | 17200 Silver Pkwy, Fenton, MI 48430-3423 | 2009-07-20 |
| 1760668941 | County Obstetrics & Gynecology, Inc | Obstetrics & Gynecology | 1011 Bowles Ave, Suite 215, Fenton, MO 63026-2387 | 2008-01-17 |
| 1053508002 | St Anthony's Physician Organization Private Practices Lc | Obstetrics & Gynecology | 714 Gravois Rd, Ste 220, Fenton, MO 63026-7723 | 2007-10-03 |
| Find all providers in FENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.