Basic Information
| Provider Information | |||||||||
| NPI: | 1861929333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTGLEN PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 SAINT LUKES CENTER DR STE 200 | ||||||||
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| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145762490 | ||||||||
| FaxNumber: | 3145762344 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CLARKSON RD | ||||||||
| Address2: | |||||||||
| City: | ELLISVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362305050 | ||||||||
| FaxNumber: | 3145905916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2017 | ||||||||
| LastUpdateDate: | 05/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 3142056301 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKES MEDICAL GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.