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General NPI Number Information
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NPI Number | 1598952541
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Entity Type | Organization
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Legal Business Name | SIDES GROUP INC.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 1216 W MAIN ST
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City | FESTUS
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State | MO
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Zip | 63028-1654
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Country | US
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Telephone | 636-937-3611
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Fax | 636-931-3612
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Provider Business Mailing Address
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Address Line | 1216 W MAIN ST
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City | FESTUS
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State | MO
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Zip | 63028-1654
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Country | US
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Telephone | 636-937-3611
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Fax | 636-931-3612
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JANET LEITTERMANN
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Credential |
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Telephone | 636-937-3611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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