1851467997 NPI number — PHYSICIAN GROUPS LC

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 1851467997 NPI number — PHYSICIAN GROUPS LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN GROUPS LC
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:
6
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:
1851467997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 MASON RIDGE CENTER DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-8573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-996-7644
Provider Business Mailing Address Fax Number:
314-996-7658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 GRAHAM RD
Provider Second Line Business Practice Location Address:
SUITE 3003
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63031-8028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-831-6883
Provider Business Practice Location Address Fax Number:
314-831-3716
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-286-2028

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com