| Organization Name: | ST. LOUIS PEDIATRICS, LLC |
| NPI Number: | 1649560558 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUSTIN OGBEVOEN (PRESIDENT) |
| Mailing Address: | 8 Ramsgate Dr Olivette |
| State: | MO US |
| Postal Code: | 631324116 |
| Phone Number: | 3142839198 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2011 |
| NPI Last Update Date: | 04/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 103771 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |