Provider Demographics
NPI:1487650545
Name:METRO HEART GROUP OF ST. LOUIS, INC.
Entity type:Organization
Organization Name:METRO HEART GROUP OF ST. LOUIS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:EREKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-880-6107
Mailing Address - Street 1:PO BOX 66754
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6754
Mailing Address - Country:US
Mailing Address - Phone:314-880-6100
Mailing Address - Fax:314-997-3248
Practice Address - Street 1:1390 HIGHWAY 61
Practice Address - Street 2:SUITE 3300
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-931-6302
Practice Address - Fax:636-933-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487650545Medicaid
ILIL4099Medicare PIN
MO000012205Medicare PIN
IL335601Medicare PIN
MO000012206Medicare PIN