Organization
CARDIOLOGY & CRITICAL CARE CONSULTANTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY JOHNSON MD (DELEGATED OFFICIAL)
(314) 781-8082
Entity
Organization
Contact information
Practice address
3915 WATSON RD, SUITE 200, SAINT LOUIS, MO 63109-1251
(314) 781-8082
Mailing address
1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R4A99
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502349004
—
MO
Enumeration date
01/27/2006
Last updated
01/20/2010
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