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NPI Code Detail

MEDICARE: HOUSE CALL DOCTORS, LLC

MEDICARE: HOUSE CALL DOCTORS, 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
1207R00000XInternal Medicine Physician
2152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000014757OTHERMOPTAN
2IL6527OTHERILPTAN

General Provider Information

NPI Number : 1871535419
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOUSE CALL DOCTORS, LLC
Provider Business Mailing Address
First Line : 2865 NETHERTON DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-4674
Country : US
Telephone Number : 314-653-0918
Fax Number :
Provider Business Practice Location Address
First Line : 2865 NETHERTON DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-4674
Country : US
Telephone Number : 314-653-0918
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : GARY PEVNICK
Credential : DPT
Telephone Number : 314-653-0918
Provider Enumeration Date : 06/11/2006
Last Update Date : 08/25/2015

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Directions to “HOUSE CALL DOCTORS, LLC ” Practice Location

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