NPIMap

Organization Active NPI

Surgical Clinic Inc

  • Family Medicine Physician
  • O Fallon, MO
National Provider Identifier
1093794927
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SURGICAL CLINIC INC
Doing business as
Family Medicine Clinic
Practice address
103 Church St
O Fallon, MO 63366-2894
Phone
(636) 240-1100
Fax
(636) 240-1104
NPI assigned
Jan 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert J Oliver, DO
Title
Doctor Office Manager
Phone
(636) 240-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

103 Church St
O Fallon, MO 63366-2894

Mailing address

103 Church St
O Fallon, MO 63366-2894
Phone (636) 240-1100

Other names 1

  • Family Medicine Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

103 Church St
O Fallon, MO 63366
Phone (636) 240-1100

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093794927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CHURCH ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662894",
            "telephone_number": "636-240-1100",
            "fax_number": "636-240-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CHURCH ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662894",
            "telephone_number": "636-240-1100",
            "fax_number": "636-240-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DOCTOR OFFICE MANAGER",
        "authorized_official_telephone_number": "636-240-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.