Provider Demographics
NPI:1871112102
Name:THRIVE ST. LOUIS, INC
Entity type:Organization
Organization Name:THRIVE ST. LOUIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-783-3040
Mailing Address - Street 1:4331 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:314-783-3043
Practice Address - Street 1:4331 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2701
Practice Address - Country:US
Practice Address - Phone:314-783-3040
Practice Address - Fax:314-783-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center