Healthcare Provider Details

I. General information

NPI: 1003804139
Provider Name (Legal Business Name): INTERMED MEDICAL CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD SUITE 210
SAINT LOUIS MO
63129-1576
US

IV. Provider business mailing address

4850 LEMAY FERRY RD SUITE 210
SAINT LOUIS MO
63129-1576
US

V. Phone/Fax

Practice location:
  • Phone: 314-892-6565
  • Fax: 314-892-4828
Mailing address:
  • Phone: 314-892-6565
  • Fax: 314-892-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT V GRIESBAUM
Title or Position: PRESIDENT
Credential: MD
Phone: 314-892-6565