| Lakeview Medical Group Inc | |
|
830 Waterbury Falls Dr Ste 202 O Fallon MO 63368-2215 | |
| (636) 278-1670 | |
| Not Available |
| Full Name | Lakeview Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 830 Waterbury Falls Dr, O Fallon, Missouri |
| Authorized Official Name and Position | Thomas F Wright (PRESIDENT) |
| Authorized Official Contact | 6363974012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeview Medical Group Inc 1630 Market Center Blvd Ste 201 O Fallon MO 63368-8407 Ph: (636) 397-4012 | Lakeview Medical Group Inc 830 Waterbury Falls Dr Ste 202 O Fallon MO 63368-2215 Ph: (636) 278-1670 |
| NPI Number | 1972721025 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 11/05/2021 |
| Medicare PECOS PAC ID | 4587691126 |
|---|---|
| Medicare Enrollment ID | O20050726000001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972721025 | NPI | - | NPPES |
| 000013627 | Other | MO | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 108025 (Missouri) | Primary |
| Provider Name | Thomas F Wright |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417935974 PECOS PAC ID: 1456381029 Enrollment ID: I20050815000459 |
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