Organization
PRIMARY CARE DE SOTO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MAXVILL (PARTNER)
(314) 398-1533
Entity
Organization
Contact information
Practice address
420 N MAIN ST, DE SOTO, MO 63020-1538
(314) 398-1533
Mailing address
420 N MAIN ST, DE SOTO, MO 63020-1538
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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