MEDICARE: FAMILY MEDICINE - SLMG SOUTH, 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

General Provider Information

NPI Number	:	1164077822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE - SLMG SOUTH, LLC

Provider Business Mailing Address
First Line	:	121 SAINT LUKES CENTER DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3518
Country	:	US
Telephone Number	:	636-685-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 PROFESSIONAL DR
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-3809
Country	:	US
Telephone Number	:	636-464-4000
Fax Number	:	636-529-0699

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DARREN R. HASKELL
Credential	:	M.D.
Telephone Number	:	314-205-6444

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	12/12/2025

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