Organization
PROFESSIONAL CARE PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY BARTLETT P.A. (PRESIDENT)
(636) 577-1357
Entity
Organization
Contact information
Practice address
723 1ST CAPITOL DR, SAINT CHARLES, MO 63301-2729
(636) 577-1357
Mailing address
2025 ZUMBEHL RD, #45, SAINT CHARLES, MO 63303-2723
(636) 577-1357
(636) 447-1202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
33327
MO
363A00000X
Physician Assistant
Primary
104933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE8055
RAILROAD MEDICARE
MO
Enumeration date
08/13/2006
Last updated
04/29/2008
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