Provider Demographics
NPI:1063458305
Name:ST ANN OB GYN INC
Entity type:Organization
Organization Name:ST ANN OB GYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTERUBIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-2880
Mailing Address - Street 1:3009 N BALLAS ROAD
Mailing Address - Street 2:SUITE 356C
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-2880
Mailing Address - Fax:314-432-4810
Practice Address - Street 1:3009 N BALLAS ROAD
Practice Address - Street 2:SUITE 356C
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-432-2880
Practice Address - Fax:314-432-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4217036OtherAETNA
101340OtherHEALTHLINK
5143OtherHEALTHCARE USA
0700216OtherMEDICARE COMPLETE
3951OtherHEALTHCARE USA
46319OtherGROUP HEALTH PLAN
4270227OtherAETNA
0700217OtherMEDICARE COMPLETE
112754OtherBLUE CROSS BLUE SHIELD
112759OtherBLUE CROSS BLUE SHIELD
SP15671OtherCIGNA
SP15678OtherCIGNA
0700217OtherUNITED HEALTHCARE
100174OtherHEALTHLINK
45077OtherGROUP HEALTH PLAN