Healthcare Provider Details

I. General information

NPI: 1285958983
Provider Name (Legal Business Name): EUCLID PRIMARY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N KINGSHIGHWAY BLVD STE 107
SAINT LOUIS MO
63115-1703
US

IV. Provider business mailing address

3737 N KINGSHIGHWAY BLVD STE 107
SAINT LOUIS MO
63115-1703
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-6644
  • Fax: 314-361-3611
Mailing address:
  • Phone: 314-361-6644
  • Fax: 314-361-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number104284
License Number StateMO

VIII. Authorized Official

Name: DR. CARMEL ROSE BOYKIN-WRIGHT
Title or Position: OWNER
Credential:
Phone: 314-361-6644