Basic Information
| Provider Information | |||||||||
| NPI: | 1124454442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MO CARDINALS EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 S SYRACUSE WAY | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034951240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3933 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631184601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148657000 | ||||||||
| FaxNumber: | 3148653337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2013 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | ZIMMERMAN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034951228 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.