# BALLWIN FAMILY MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. LUKES MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790204311
- **Legal business name:** ST. LUKES MEDICAL GROUP
- **Authorized official:** JAMES SNIDER (DIRECTOR)
- **Authorized official phone:** (636) 685-7804

## Contact information

- **Practice address:** 653 BIG BEND RD, MANCHESTER, MO 63021-7723
- **Practice address phone:** (314) 434-1500
- **Mailing address:** 653 BIG BEND RD, MANCHESTER, MO 63021-7723
- **Mailing address phone:** (314) 434-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/14/2017
- **Last updated:** 01/27/2022