Healthcare Provider Details

I. General information

NPI: 1992802433
Provider Name (Legal Business Name): RC PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 WATSON RD.
ST LOUIS MO
63126
US

IV. Provider business mailing address

9200 WATSON RD.
ST LOUIS MO
63126
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24807
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN WALTERSCHEID
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-962-6700