Provider Demographics
NPI:1063959104
Name:SOUTHERN MISSOURI INFECTIOUS DISEASE SPECIALISTS LLC
Entity type:Organization
Organization Name:SOUTHERN MISSOURI INFECTIOUS DISEASE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:C
Authorized Official - Last Name:TORRENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-375-4153
Mailing Address - Street 1:PO BOX 270240
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-0240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1447 US HIGHWAY 61 STE C
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4151
Practice Address - Country:US
Practice Address - Phone:636-375-4153
Practice Address - Fax:636-333-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty