MEDICARE: CHESTERFIELD VALLEY GASTROENTEROLOGY 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1104119916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTERFIELD VALLEY GASTROENTEROLOGY LLC

Provider Business Mailing Address
First Line	:	100 CHESTERFIELD BUSINESS PKWY STE 110
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1271
Country	:	US
Telephone Number	:	636-532-0990
Fax Number	:	636-532-0993

Provider Business Practice Location Address
First Line	:	100 CHESTERFIELD BUSINESS PKWY STE 110
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1271
Country	:	US
Telephone Number	:	636-532-0990
Fax Number	:	636-532-0993

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. HELEN KIM-JAMES
Credential	:	MD
Telephone Number	:	636-532-0990

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	08/10/2011

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