Healthcare Provider Details

I. General information

NPI: 1346343910
Provider Name (Legal Business Name): TOWN AND COUNTRY PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 141
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

3009 N BALLAS RD STE 141
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-0209
  • Fax: 314-994-9130
Mailing address:
  • Phone: 314-994-0209
  • Fax: 314-994-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMOR7D83
License Number StateMO

VIII. Authorized Official

Name: DR. JOEL SHOLTER KOENIG
Title or Position: PRESIDENT
Credential: MD
Phone: 314-994-0209