Organization
PRIMARY CARE OF BONNE TERRE LLC
Active
Other names
Primary Care of Bonne Terre
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW J NINICHUCK MD (OWNER)
(573) 358-9119
Entity
Organization
Contact information
Practice address
527 BENHAM ST, BONNE TERRE, MO 63628-1205
(573) 358-9119
(573) 358-9489
Mailing address
527 BENHAM ST, BONNE TERRE, MO 63628-1205
(573) 358-9119
(573) 358-9489
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
06/17/2015
Last updated
11/23/2015
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