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General NPI Number Information
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NPI Number | 1386148849
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Entity Type | Organization
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Legal Business Name | JEFFERSON COUNTY PHYSICIANS
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 420 W MAIN ST
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City | FESTUS
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State | MO
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Zip | 63028-1800
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Country | US
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Telephone | 636-937-0025
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Fax | 636-937-7942
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Provider Business Mailing Address
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Address Line | 420 W MAIN ST
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City | FESTUS
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State | MO
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Zip | 63028-1800
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Country | US
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Telephone | 636-937-0025
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Fax | 636-937-7942
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Authorized Official
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Title or Position | SENIOR BILLER
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Name | MRS. PATRICIA MARIE BOOKER
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Credential |
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Telephone | 636-937-7481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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