Unknown Individual – Family Medicine Physician, NPI 1356475818
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
670 MASON RIDGE CENTER DR
STE 300
SAINT LOUIS, MO 631418573
Phone: (314) 996-7644
Fax: (314) 996-7658
Type: Mailing
1021 E HIGHWAY 22
CENTRALIA, MO 652401183
Phone: (573) 682-5588
Fax: (573) 682-1539
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63141)
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