Active NPI
Mid-Town Medical Practice, LLC
- Internal Medicine Physician
- Creve Coeur, MO
National Provider Identifier
1023467008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- MID-TOWN MEDICAL PRACTICE, LLC
- Practice address
- 9 Sackston Woods LN
Creve Coeur, MO 63141-8228 - Phone
- (314) 651-6132
- NPI assigned
- Jun 9, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Iqbal Amin, M.D.
- Title
- President
- Phone
- (314) 651-6132
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
9 Sackston Woods LN
Creve Coeur, MO 63141-8228
Mailing address
424 W 4TH St
Waterloo, IL 62298-1378
Phone (877) 748-7030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
102 N Main St
#3
Columbia, IL 62236
424 W 4th St
Waterloo, IL 62298
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Saint Louis, MO
- NPI 1184619835
-
- Gerontology Clinical Nurse Specialist
- Creve Coeur, MO
- NPI 1184175085
-
- Family Nurse Practitioner
- Saint Louis, MO
- NPI 1104121102
-
- Family Nurse Practitioner
- Saint Peters, MO
- NPI 1447817952
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465430400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1465430400000",
"number": "1023467008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 W 4TH ST",
"city": "WATERLOO",
"state": "IL",
"postal_code": "622981378",
"telephone_number": "877-748-7030",
"fax_number": "877-264-9140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 SACKSTON WOODS LN",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "631418228",
"telephone_number": "314-651-6132"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MID-TOWN MEDICAL PRACTICE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-06-09",
"last_updated": "2016-06-09",
"status": "A",
"authorized_official_last_name": "AMIN",
"authorized_official_first_name": "IQBAL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "314-651-6132",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.