Healthcare Provider Details

I. General information

NPI: 1275921306
Provider Name (Legal Business Name): ASSOCIATED PHYSICIANS GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 TALON DR STE 102
O FALLON IL
62269-1848
US

IV. Provider business mailing address

845 N NEW BALLAS CT SUITE 120
CREVE COEUR MO
63141-7134
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-8211
  • Fax: 618-628-0883
Mailing address:
  • Phone: 314-200-0997
  • Fax: 618-628-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHURCH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 618-628-8211