MEDICARE: CHARLES S FILLINGANE II DO

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	P7438	TX
2	207Q00000X	Family Medicine Physician	R-8941	IA
3	207Q00000X	Family Medicine Physician	2016039415	MO

General Provider Information

NPI Number	:	1275854465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES S FILLINGANE II DO

Provider Business Mailing Address
First Line	:	422 N MAIN ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-1609
Country	:	US
Telephone Number	:	660-220-2123
Fax Number	:	833-974-2428

Provider Business Practice Location Address
First Line	:	422 N MAIN ST
Second Line	:
City	:	MARYVILLE
State	:	MO
Zip	:	64468-1609
Country	:	US
Telephone Number	:	660-220-2123
Fax Number	:	833-974-2428

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	05/28/2026

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