Organization
PHYSICIAN GROUPS LC
Active
Other names
Medical Arts Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN CANTER-KOESTER (VP OPERATIONS AND STRATEGY)
(314) 996-7610
Entity
Organization
Contact information
Practice address
1103 W LIBERTY, FARMINGTON, MO 63640-1921
(573) 756-7651
(573) 756-6807
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7644
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500590104
—
MO
05
—
596052704
—
MO
Enumeration date
12/29/2006
Last updated
08/11/2016
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