Healthcare Provider Details

I. General information

NPI: 1205112331
Provider Name (Legal Business Name): CEDAR HILL PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 THE CEDARS CT
CEDAR HILL MO
63016-2206
US

IV. Provider business mailing address

6420 THE CEDARS CT
CEDAR HILL MO
63016-2206
US

V. Phone/Fax

Practice location:
  • Phone: 636-274-2700
  • Fax: 636-274-4660
Mailing address:
  • Phone: 636-274-2700
  • Fax: 636-274-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ADAMS
Title or Position: SVP REGIONAL OPERATIONS, TENET
Credential:
Phone: 469-893-2563