Provider Demographics
NPI:1932192937
Name:CEDAR HILL FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:CEDAR HILL FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-274-7457
Mailing Address - Street 1:6420 THE CEDARS CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-2222
Mailing Address - Country:US
Mailing Address - Phone:636-274-2700
Mailing Address - Fax:636-274-4660
Practice Address - Street 1:6420 THE CEDARS CT
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2222
Practice Address - Country:US
Practice Address - Phone:636-274-2700
Practice Address - Fax:636-274-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO50825909Medicaid