PHYSICIAN GROUPS LC NPI 1043386162

NPI Information

PHYSICIAN GROUPS LC is a primary care clinic center in Florissant, MO. PHYSICIAN GROUPS LC NPI is 1043386162. The provider is registered as an organization entity type.
The provider Is Doing Business As Northwest Physicians.

The provider's business location address is:

1225 GRAHAM RD
SUITE 220
FLORISSANT, MO
ZIP 63031-014
Phone: (314) 838-6700
Fax: (314) 838-6020

The provider's authorized official is Raymond P Davidson .
The authorized official title is President and has the following contact phone number (314) 286-2028.

The CLIA number assigned to this NPI record is 26D0906517 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 3/26/2008.

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:

Other Identifiers

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

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