Organization
MERAMEC VALLEY OBGYN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK E RICKETTS MD (OWNER PRESIDENT)
(636) 343-1144
Entity
Organization
Contact information
Practice address
408 GRAVOIS RD, FENTON, MO 63026
(636) 343-1144
(636) 343-6624
Mailing address
PO BOX 824, FENTON, MO 63026
(636) 343-1144
(636) 343-6624
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
R5C65
MO
Other
Enumeration date
04/10/2007
Last updated
02/26/2008
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