Provider Demographics
NPI:1386809663
Name:ST LOUIS CARDIOLOGY CONSULTANTS LTD
Entity type:Organization
Organization Name:ST LOUIS CARDIOLOGY CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:THANAVARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-653-5824
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:SUITE 2346
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-5125
Mailing Address - Fax:314-653-4321
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:SUITE 2346
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-653-5125
Practice Address - Fax:314-653-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011207Medicare PIN