S&J of South County LLC

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

2001009169 Issued in MO

Legal business name

S&J OF SOUTH COUNTY LLC

Practice address

11188 Tesson Ferry Rd
Suite 101
Saint Louis, MO 63123-6962

Phone

(636) 717-6717

NPI assigned

Aug 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shirley S Joo, M.D.

Title

Manager

Phone

(314) 302-0736

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Allergy Care Specialists Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418601600000",
    "number": "1053691709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 LONG MEADOWS LN",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631313014",
            "telephone_number": "314-302-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11188 TESSON FERRY RD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236962",
            "telephone_number": "636-717-6717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S&J OF SOUTH COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2014-12-15",
        "status": "A",
        "authorized_official_last_name": "JOO",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-302-0736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MO",
            "license": "2001009169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144262825",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allergy Care Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.