Basic Information
| Provider Information | |||||||||
| NPI: | 1811087604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MULTI-CARE SPECIALISTS P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 505118 | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631505118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186929640 | ||||||||
| FaxNumber: | 6186929643 | ||||||||
| Practice Location | |||||||||
| Address1: | 3986 MARYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | GRANITE CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620404191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187970618 | ||||||||
| FaxNumber: | 6187972243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | JONATHON | ||||||||
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| AuthorizedOfficialTitleorPosition: | V-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6187970618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPC | ||||||||
| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036099405 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036085633 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 225100000X | 070008964 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 111N00000X | 036099405 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.