MEDICARE: INTERMED MEDICAL CONSULTANTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1003804139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMED MEDICAL CONSULTANTS INC

Provider Business Mailing Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	SUITE 210
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-892-6565
Fax Number	:	314-892-4828

Provider Business Practice Location Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	SUITE 210
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-892-6565
Fax Number	:	314-892-4828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT V GRIESBAUM
Credential	:	MD
Telephone Number	:	314-892-6565

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/28/2008

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