PHYSICIAN CORRECTIONAL USA (MO.) LLC NPI 1548061294

NPI Information

  • NPI: 1548061294
  • Provider Name: PHYSICIAN CORRECTIONAL USA (MO.), LLC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 200 S TUCKER BLVD
    SAINT LOUIS, MO
    ZIP 63102
  • Phone: (812) 499-3023

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NPI Details

PHYSICIAN CORRECTIONAL USA (MO.), LLC is a general practice in Saint Louis, MO. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PHYSICIAN CORRECTIONAL USA (MO.), LLC NPI is 1548061294. The provider is registered as an organization entity type.

The provider's business location address is:

200 S TUCKER BLVD
SAINT LOUIS, MO
ZIP 63102-152
Phone: (812) 499-3023
Fax: (207) 419-6186

The provider's authorized official is James R Martin .
The authorized official title is Chief Operating Officer and has the following contact phone number (812) 499-3023.

The enumeration date for this NPI number is 3/20/2025 and was last updated on 3/20/2025.

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
1207R00000XInternal MedicineNo
2208D00000XGeneral PracticeYes

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
1LC14503852OTHERMISSOURIMISSOURI CHARTER #

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: 11/21/2025

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