Provider Type Icon

MERCY CLINIC BURN AND PLASTIC SURGERY LLC NPI 1912037433


NPI Information

NPI: 1912037433
Provider Name: MERCY CLINIC BURN AND PLASTIC SURGERY, LLC

Former Legal Business Name: MERCY BURN & PLASTIC SURGERY

Classification: Surgery - 2086S0122X
Entity Type: Organization

Specialization: Plastic and Reconstructive Surgery

CLIA Number: 26D0441254

Address:
621 S. NEW BALLAS ROAD
SUITE 7003-B
ST. LOUIS, MO
ZIP 63141
Phone: (314) 251-5570
Get Directions

MERCY CLINIC BURN AND PLASTIC SURGERY, LLC is a plastic and reconstructive surgery surgery in St. Louis, MO. The provider is a surgeon who specializes in plastic and reconstructive surgery. MERCY CLINIC BURN AND PLASTIC SURGERY, LLC NPI is 1912037433. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Mercy Burn & Plastic Surgery.

The provider's business location address is:

621 S. NEW BALLAS ROAD
SUITE 7003-B
ST. LOUIS, MO
ZIP 63141-275
Phone: (314) 251-5570
Fax: (314) 251-5571

The provider's authorized official is John W. Hubert .
The authorized official title is President and has the following contact phone number (314) 251-1700.

The CLIA number assigned to this NPI record is 26D0441254 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/6/2007 and was last updated on 11/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208200000XPlastic SurgeryNo
22086S0122XSurgeryPlastic and Reconstructive SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1506063908MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.