Provider Demographics
NPI:1891538559
Name:TOWN & COUNTRY DERMATOLOGY LLC
Entity type:Organization
Organization Name:TOWN & COUNTRY DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MACKENZIE
Authorized Official - Last Name:MACARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-785-3376
Mailing Address - Street 1:21 WESTWOOD COUNTRY CLB
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2411
Mailing Address - Country:US
Mailing Address - Phone:888-785-3376
Mailing Address - Fax:
Practice Address - Street 1:555 N NEW BALLAS RD STE 160
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:888-785-3376
Practice Address - Fax:866-326-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty