Provider Demographics
NPI:1154571776
Name:CLAYTON PRIMARY CARE GROUP, INC
Entity type:Organization
Organization Name:CLAYTON PRIMARY CARE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:314-872-9900
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 300 A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-872-9900
Mailing Address - Fax:314-872-3939
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 300 A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-872-9900
Practice Address - Fax:314-872-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty