Organization
INTERNAL MEDICINE & GASTROENTEROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACK E MCCAIN M.D. (PRESIDENT)
(314) 522-1834
Entity
Organization
Contact information
Practice address
10121 W FLORISSANT AVE, SAINT LOUIS, MO 63136-2103
(314) 522-1834
(314) 522-6149
Mailing address
PO BOX 21549, SAINT LOUIS, MO 63132-0549
(314) 522-1834
(314) 522-6149
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
R6F90
MO
Other
Enumeration date
09/09/2008
Last updated
10/11/2011
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