| Specialty And Primary Care Llc | |
|
10004 Kennerly Rd 257 A Saint Louis MO 63128-2141 | |
| (314) 842-6333 | |
| (314) 543-5271 |
| Full Name | Specialty And Primary Care Llc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 10004 Kennerly Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Zafar Quader (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3148426333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialty And Primary Care Llc 10004 Kennerly Rd 257 A Saint Louis MO 63128-2141 Ph: (314) 842-6333 | Specialty And Primary Care Llc 10004 Kennerly Rd 257 A Saint Louis MO 63128-2141 Ph: (314) 842-6333 |
| NPI Number | 1174742720 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 10/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174742720 | NPI | - | NPPES |
| 361744184 | Medicaid | IL | |
| 208721902 | Medicaid | MO | |
| DA8910 | Other | MO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 109425 (Missouri) | Primary |
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