| Internal Medicine Consultants Ii, Llc | |
|
456 N New Ballas Rd Suite 299 Saint Louis MO 63141-6831 | |
| (314) 569-1090 | |
| (314) 569-1424 |
| Full Name | Internal Medicine Consultants Ii, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 456 N New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Matthew Bosner (DELEGATED OFFICIAL) |
| Authorized Official Contact | 3145691090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Consultants Ii, Llc 1836 Lackland Hill Pkwy Saint Louis MO 63146-3572 Ph: (314) 989-0300 | Internal Medicine Consultants Ii, Llc 456 N New Ballas Rd Suite 299 Saint Louis MO 63141-6831 Ph: (314) 569-1090 |
| NPI Number | 1992776801 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 09/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992776801 | NPI | - | NPPES |
| 501466205 | Medicaid | MO | |
| CP7862 | Other | MO | RR MEDICARE GROUP# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | R6A89 (Missouri) | Primary |
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