| Specialist In Gastroenterology | |
|
11525 Olde Cabin Rd Creve Coeur MO 63141-7146 | |
| (314) 997-0554 | |
| (314) 997-5086 |
| Full Name | Specialist In Gastroenterology |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 11525 Olde Cabin Rd, Creve Coeur, Missouri |
| Authorized Official Name and Position | Paula D Willis (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 3149970554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialist In Gastroenterology 11525 Olde Cabin Rd Creve Coeur MO 63141-7146 Ph: (314) 997-0554 | Specialist In Gastroenterology 11525 Olde Cabin Rd Creve Coeur MO 63141-7146 Ph: (314) 997-0554 |
| NPI Number | 1669523270 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 04/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669523270 | NPI | - | NPPES |
| 501218002 | Medicaid | MO | |
| 000012657 | Other | MO | MEDICARE |
| CG0207 | Other | RAILROAD MEDICARE | |
| 31998 | Other | GHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | R4F99 (Missouri) | Primary |
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