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NPI Code Detail

MEDICARE: INTERNAL MEDICINE & GASTROENTEROLOGY LLC

MEDICARE: INTERNAL MEDICINE & GASTROENTEROLOGY 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
1302F00000XExclusive Provider OrganizationR6F90MO

General Provider Information

NPI Number : 1932358421
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNAL MEDICINE & GASTROENTEROLOGY LLC
Provider Business Mailing Address
First Line : PO BOX 21549
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-0549
Country : US
Telephone Number : 314-522-1834
Fax Number : 314-522-6149
Provider Business Practice Location Address
First Line : 10121 W FLORISSANT AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-2103
Country : US
Telephone Number : 314-522-1834
Fax Number : 314-522-6149
Authorized Official
Title or Position : PRESIDENT
Name : MACK E MCCAIN
Credential : M.D.
Telephone Number : 314-522-1834
Provider Enumeration Date : 09/09/2008
Last Update Date : 10/11/2011

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Directions to “INTERNAL MEDICINE & GASTROENTEROLOGY LLC ” Practice Location

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