Organization
PREMIER MEDICAL SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOE JENSEN (ADMINISTRATOR)
(314) 821-5850
Entity
Organization
Contact information
Practice address
2345 DOUGHERTY FERRY RD, SAINT LOUIS, MO 63122-3313
(314) 821-5850
Mailing address
2345 DOUGHERTY FERRY RD, SAINT LOUIS, MO 63122-3313
(314) 821-5850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558542506
—
MO
01
—
DO9596
RR MEDICARE
MO
Enumeration date
11/19/2007
Last updated
06/17/2011
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