Healthcare Provider Details

I. General information

NPI: 1285720169
Provider Name (Legal Business Name): TRI-COUNTY FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 WINGHAVEN BLVD STE 142
O FALLON MO
63368-3618
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-2510
  • Fax: 314-590-5914
Mailing address:
  • Phone: 636-685-7804
  • Fax:

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: DARREN R. HASKELL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD.
Phone: 314-205-6444