Provider Demographics
NPI:1386148849
Name:JEFFERSON COUNTY PHYSICIANS
Entity type:Organization
Organization Name:JEFFERSON COUNTY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-937-7481
Mailing Address - Street 1:420 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1800
Mailing Address - Country:US
Mailing Address - Phone:636-937-0025
Mailing Address - Fax:636-937-7942
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1800
Practice Address - Country:US
Practice Address - Phone:636-937-0025
Practice Address - Fax:636-937-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty