| Specialty & Primary Care Llc | |
|
3009 N Ballas Rd Suite 229a Saint Louis MO 63131-2322 | |
| (314) 432-5144 | |
| (314) 432-2400 |
| Full Name | Specialty & Primary Care Llc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 3009 N Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Nayyer Ibrahim (ADMINISTRATOR) |
| Authorized Official Contact | 3144325144 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialty & Primary Care Llc 3009 N Ballas Rd Suite 229a Saint Louis MO 63131-2322 Ph: (314) 432-5144 | Specialty & Primary Care Llc 3009 N Ballas Rd Suite 229a Saint Louis MO 63131-2322 Ph: (314) 432-5144 |
| NPI Number | 1104954692 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 03/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104954692 | NPI | - | NPPES |
| 361744184 | Medicaid | IL | |
| 208721902 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 109425 (Missouri) | Primary |
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