| South County Endocrinology And Obesity Medicine Llc | |
|
12900 Tesson Ferry Rd Ste 101 Saint Louis MO 63128-3002 | |
| (314) 843-4848 | |
| (866) 510-2730 |
| Full Name | South County Endocrinology And Obesity Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12900 Tesson Ferry Rd Ste 101, Saint Louis, Missouri |
| Authorized Official Name and Position | Bharathi Raju (SOLE MEMBER) |
| Authorized Official Contact | 6362365820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South County Endocrinology And Obesity Medicine Llc 12900 Tesson Ferry Rd Ste 101 Saint Louis MO 63128-3002 Ph: (314) 843-4848 | South County Endocrinology And Obesity Medicine Llc 12900 Tesson Ferry Rd Ste 101 Saint Louis MO 63128-3002 Ph: (314) 843-4848 |
| NPI Number | 1144564196 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 09/16/2019 |
| Medicare PECOS PAC ID | 2668619669 |
|---|---|
| Medicare Enrollment ID | O20130510000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144564196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 2001005643 (Missouri) | Primary |
| Provider Name | Bharathi Raju |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1720078843 PECOS PAC ID: 5294751632 Enrollment ID: I20051014000840 |
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