Provider Demographics
NPI:1295996023
Name:NEIGHBORHOOD MED CENTER LLC
Entity type:Organization
Organization Name:NEIGHBORHOOD MED CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-723-0414
Mailing Address - Street 1:522 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6857
Mailing Address - Country:US
Mailing Address - Phone:314-567-6464
Mailing Address - Fax:314-567-6471
Practice Address - Street 1:522 N NEW BALLAS RD
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6857
Practice Address - Country:US
Practice Address - Phone:314-567-6464
Practice Address - Fax:314-567-6471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIGHBORHOOD MED CENTER LLC DBA ST LOUIS TOP DOCS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021770261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1221Medicare PIN