MEDICARE: WEST COUNTY FAMILY MEDICINE, 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	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center	R8687	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	:	1598823478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COUNTY FAMILY MEDICINE, INC

Provider Business Mailing Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	STE 320
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-821-6889
Fax Number	:	314-821-1887

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	STE 320
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-821-6889
Fax Number	:	314-821-1887

Authorized Official
Title or Position	:	PRESIDENT, PHYSICIAN
Name	:	DR. DAVID NORMAN KANTOR
Credential	:	D.O.
Telephone Number	:	314-821-6889

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/05/2008

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Directions to “WEST COUNTY FAMILY MEDICINE, INC ” Practice Location

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