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BRIDGETON GERIATRICS LLC NPI 1245652924


NPI Information

NPI: 1245652924
Provider Name: BRIDGETON GERIATRICS LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
12800 BOENKER LN
BRIDGETON, MO
ZIP 63044
Phone: (314) 551-0338
Get Directions

BRIDGETON GERIATRICS LLC is a family medicine in Bridgeton, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BRIDGETON GERIATRICS LLC NPI is 1245652924. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

12800 BOENKER LN
BRIDGETON, MO
ZIP 63044-438
Phone: (314) 551-0338
Fax: (314) 551-0336

The provider's authorized official is David A Smith .
The authorized official title is Owner and has the following contact phone number (314) 551-0338.

The enumeration date for this NPI number is 1/14/2014 and was last updated on 1/14/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine104361MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12083138069MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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