Provider Demographics
NPI:1700768603
Name:GCP ACO 2 LLC
Entity type:Organization
Organization Name:GCP ACO 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-925-0903
Mailing Address - Street 1:10426 BAUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1905
Mailing Address - Country:US
Mailing Address - Phone:314-925-0903
Mailing Address - Fax:
Practice Address - Street 1:623 HAMACHER ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1786
Practice Address - Country:US
Practice Address - Phone:314-925-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATION CLINICAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty