Provider Demographics
NPI:1174965834
Name:SCOTT A KIRCHNER MD LLC
Entity type:Organization
Organization Name:SCOTT A KIRCHNER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-645-8719
Mailing Address - Street 1:6555 CHIPPEWA ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-4110
Mailing Address - Country:US
Mailing Address - Phone:314-645-8719
Mailing Address - Fax:314-645-8642
Practice Address - Street 1:6555 CHIPPEWA ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-4110
Practice Address - Country:US
Practice Address - Phone:314-645-8719
Practice Address - Fax:314-645-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3C11261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11500Medicare UPIN
MO000005297Medicare PIN