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General NPI Number Information
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NPI Number | 1922260132
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Entity Type | Organization
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Legal Business Name | MIDWEST HEMORRHOID TREATMENT CENTER TOWN & COUNTRY LLC
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Dates
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Enumeration Date | 06/29/2008
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 450 N NEW BALLAS RD SUITE 266
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City | CREVE COEUR
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State | MO
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Zip | 63141-6835
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Country | US
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Telephone | 314-991-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 450 N NEW BALLAS RD STE 266N
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City | CREVE COEUR
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State | MO
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Zip | 63141-6859
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Country | US
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Telephone | 313-991-9888
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Fax |
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Authorized Official
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Title or Position | MD
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Name | BETSY F. CLEMENS
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Credential | MD
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Telephone | 314-991-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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