NPIMap

Organization Active NPI

Maryland Medical Group LTD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1104870021
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARYLAND MEDICAL GROUP LTD
Practice address
1110 Highlands Plaza Drive East
Suite 375
Saint Louis, MO 63110-1340
Phone
(314) 367-3113
Fax
(314) 367-6491
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Authorized official

Name
Dr. William G Bowen, MDNPI 1609815950
Title
President
Phone
(314) 367-3113

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1110 Highlands Plaza Drive East
Suite 375
Saint Louis, MO 63110-1340

Mailing address

1110 Highlands Plaza Dr E
Suite 375
Saint Louis, MO 63110-1340
Phone (314) 367-3113

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0438358Maryland Medical Group, LTD1110 Highlands Plaza Drive East, Ste 375, Saint Louis, MO 63110Provider-performed microscopyApr 21, 2027

National Provider Directory

National Provider Directory

Locations

4652 Maryland Ave
Saint Louis, MO 63108
Phone (314) 367-3113

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1104870021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 HIGHLANDS PLAZA DR E",
            "address_2": "SUITE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101340",
            "telephone_number": "314-367-3113",
            "fax_number": "314-367-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HIGHLANDS PLAZA DRIVE EAST",
            "address_2": "SUITE 375",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101340",
            "telephone_number": "314-367-3113",
            "fax_number": "314-367-6491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-367-3113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.