MEDICARE: CRITICAL CARE MANAGEMENT GROUP, 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE1800	OTHER	MO	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1679520720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITICAL CARE MANAGEMENT GROUP, LLC

Provider Business Mailing Address
First Line	:	3533 DUNN RD
Second Line	:	SUITE 210
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6761
Country	:	US
Telephone Number	:	314-921-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 DUNN RD
Second Line	:	SUITE 210
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6761
Country	:	US
Telephone Number	:	314-921-2250
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT J SIMPSON
Credential	:	DO
Telephone Number	:	314-921-2250

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/06/2009

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