Healthcare Provider Details

I. General information

NPI: 1063959104
Provider Name (Legal Business Name): SOUTHERN MISSOURI INFECTIOUS DISEASE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 US HIGHWAY 61 STE C
FESTUS MO
63028-4151
US

IV. Provider business mailing address

PO BOX 270240
SAINT LOUIS MO
63127-0240
US

V. Phone/Fax

Practice location:
  • Phone: 636-375-4153
  • Fax: 636-333-4510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLON C TORRENTO
Title or Position: OWNER
Credential: MD
Phone: 636-375-4153