MEDICARE: FAMILY PHYSICIANS CARE, SOUTH COUNTY, LLC

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	207Q00000X	Family Medicine Physician	R1H07	MO

General Provider Information

NPI Number	:	1033273701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICIANS CARE, SOUTH COUNTY, LLC

Provider Business Mailing Address
First Line	:	414 SPRING AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2635
Country	:	US
Telephone Number	:	314-558-4111
Fax Number	:	314-558-4111

Provider Business Practice Location Address
First Line	:	414 SPRING AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2635
Country	:	US
Telephone Number	:	314-558-4111
Fax Number	:	314-558-4111

Authorized Official
Title or Position	:	MEMBER AND OWNER
Name	:	DR. MARY E FOX
Credential	:	MD
Telephone Number	:	314-558-4111

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	02/05/2013

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