MEDICARE: AMY C RAUCHWAY D.O.

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	2084N0400X	Neurology Physician	2005011420	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00987639	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053336859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY C RAUCHWAY D.O.

Provider Business Mailing Address
First Line	:	1176 TOWN & COUNTRY COMMONS
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017
Country	:	US
Telephone Number	:	636-893-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 TOWN AND COUNTRY COMMONS
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-8200
Country	:	US
Telephone Number	:	636-893-1260
Fax Number	:	636-893-1261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/04/2014

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