1235300286 NPI number — INTERNAL MEDICINE & GERIATRICS ASSOCIATES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235300286 NPI number — INTERNAL MEDICINE & GERIATRICS ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE & GERIATRICS ASSOCIATES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235300286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1836 LACKLAND HILL PKWY
Provider Second Line Business Mailing Address:
ATTN CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-872-1308
Provider Business Mailing Address Fax Number:
314-810-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 JUNGERMANN CIR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-916-9091
Provider Business Practice Location Address Fax Number:
636-447-9059
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ASADULLAH
Authorized Official First Name:
SAIRA
Authorized Official Middle Name:
MIR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-916-9091

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  2005014820 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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