Organization
PHYSICIAN CORRECTIONAL USA (MO.), LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES R MARTIN MPSA, CCHP (CHIEF OPERATING OFFICER)
(812) 499-3023
Entity
Organization
Contact information
Practice address
200 S TUCKER BLVD, SAINT LOUIS, MO 63102-1152
(812) 499-3023
(207) 419-6186
Mailing address
1650 SE 17TH ST STE 408, FT LAUDERDALE, FL 33316-1740
(812) 499-3023
(207) 419-6186
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC14503852
MISSOURI CHARTER #
MO
Enumeration date
03/20/2025
Last updated
03/20/2025
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