| Physician Correctional Usa (mo.), Llc | |
|
200 S Tucker Blvd Saint Louis MO 63102-1152 | |
| (812) 499-3023 | |
| (207) 419-6186 |
| Full Name | Physician Correctional Usa (mo.), Llc |
|---|---|
| Speciality | General Practice |
| Location | 200 S Tucker Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | James R Martin (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8124993023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Correctional Usa (mo.), Llc 1650 Se 17th St Ste 408 Ft Lauderdale FL 33316-1740 Ph: (812) 499-3023 | Physician Correctional Usa (mo.), Llc 200 S Tucker Blvd Saint Louis MO 63102-1152 Ph: (812) 499-3023 |
| NPI Number | 1548061294 |
|---|---|
| Provider Enumeration Date | 03/20/2025 |
| Last Update Date | 03/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548061294 | NPI | - | NPPES |
| LC14503852 | Other | MO | MISSOURI CHARTER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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