Healthcare Provider Details
I. General information
NPI: 1679760565
Provider Name (Legal Business Name): PATIENTS FIRST HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
450 CUMBERLAND WAY STE A
SULLIVAN MO
63080-3325
US
IV. Provider business mailing address
901 PATIENTS FIRST DR
WASHINGTON MO
63090-4700
US
V. Phone/Fax
- Phone: 573-468-2006
- Fax: 573-468-2026
- Phone: 636-390-1400
- Fax: 636-390-1439
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MICHAEL
E
RAU
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 636-390-1400