Provider Demographics
NPI:1700927993
Name:CAROLYN J ONEILL INC
Entity type:Organization
Organization Name:CAROLYN J ONEILL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:BCO BADO
Authorized Official - Phone:314-726-1818
Mailing Address - Street 1:1034 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 1880
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1218
Mailing Address - Country:US
Mailing Address - Phone:314-726-1818
Mailing Address - Fax:314-726-0295
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 1880
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1218
Practice Address - Country:US
Practice Address - Phone:314-726-1818
Practice Address - Fax:314-726-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO07113291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
8364OtherHEALTHCARE USA
31412OtherBLUE CROSS BLUE SHIELD
4649OtherGHP ADVENTRA
BLC24049OtherBLUE CHOICE
889058OtherCOMMUNITY CARE PLUS
4649OtherGHP ADVENTRA
889058OtherCOMMUNITY CARE PLUS
IL=========001Medicaid