| Bridgeton Geriatrics Llc | |
|
12800 Boenker Ln Bridgeton MO 63044-2438 | |
| (314) 551-0338 | |
| (314) 551-0336 |
| Full Name | Bridgeton Geriatrics Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 12800 Boenker Ln, Bridgeton, Missouri |
| Authorized Official Name and Position | David A Smith (OWNER) |
| Authorized Official Contact | 3145510338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeton Geriatrics Llc 12800 Boenker Ln Bridgeton MO 63044-2438 Ph: (314) 551-0338 | Bridgeton Geriatrics Llc 12800 Boenker Ln Bridgeton MO 63044-2438 Ph: (314) 551-0338 |
| NPI Number | 1245652924 |
|---|---|
| Provider Enumeration Date | 01/14/2014 |
| Last Update Date | 01/14/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245652924 | NPI | - | NPPES |
| 2083138069 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 104361 (Missouri) | Primary |
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