MEDICARE: FLORISSANT PEDIATRICS 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	208000000X	Pediatrics Physician	R8596	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1245349281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORISSANT PEDIATRICS INC

Provider Business Mailing Address
First Line	:	PO BOX 1209
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-0209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4129 N US HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2825
Country	:	US
Telephone Number	:	314-355-6390
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELINOR HANCOCK
Credential	:	M.D.
Telephone Number	:	314-355-6390

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/16/2012

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Directions to “FLORISSANT PEDIATRICS INC ” Practice Location

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