Bridgeton Geriatrics Llc | |
12800 Boenker Ln Bridgeton MO 63044-2438 | |
(314) 551-0338 | |
(314) 551-0336 |
Full Name | Bridgeton Geriatrics Llc |
---|---|
Speciality | Family Medicine |
Location | 12800 Boenker Ln, Bridgeton, Missouri |
Authorized Official Name and Position | David A Smith (OWNER) |
Authorized Official Contact | 3145510338 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Bridgeton Geriatrics Llc 12800 Boenker Ln Bridgeton MO 63044-2438 Ph: (314) 551-0338 | Bridgeton Geriatrics Llc 12800 Boenker Ln Bridgeton MO 63044-2438 Ph: (314) 551-0338 |
NPI Number | 1245652924 |
---|---|
Provider Enumeration Date | 01/14/2014 |
Last Update Date | 01/14/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245652924 | NPI | - | NPPES |
2083138069 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 104361 (Missouri) | Primary |
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