Healthcare Provider Details

I. General information

NPI: 1891962072
Provider Name (Legal Business Name): TED C. VARGAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N 1ST ST
PACIFIC MO
63069-1505
US

IV. Provider business mailing address

319 N 1ST ST
PACIFIC MO
63069-1505
US

V. Phone/Fax

Practice location:
  • Phone: 636-271-3500
  • Fax: 636-271-9955
Mailing address:
  • Phone: 636-271-3500
  • Fax: 636-271-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34914
License Number StateMO

VIII. Authorized Official

Name: DR. TEODORO C. VARGAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 636-271-3500