MEDICARE: INSTITUTE OF MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1023592946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF MEDICINE LLC

Provider Business Mailing Address
First Line	:	6824 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2603
Country	:	US
Telephone Number	:	317-595-0601
Fax Number	:

Provider Business Practice Location Address
First Line	:	6824 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2603
Country	:	US
Telephone Number	:	317-595-0601
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RYAN PATRICK OSHAUGHNESSY
Credential	:
Telephone Number	:	317-595-0601

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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Directions to “INSTITUTE OF MEDICINE LLC ” Practice Location

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