Blue Bayou Service Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

12345 Issued in MO

Legal business name

BLUE BAYOU SERVICE INC

Practice address

1310 Papin St
Saint Louis, MO 63103-3132

Phone

(314) 502-1300

NPI assigned

Aug 7, 2012

Organization subpart

No

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

Authorized official

Name

William Bronson

Title

Ceo

Phone

(314) 502-1300

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1144577305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 PAPIN ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631033132",
            "telephone_number": "314-502-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 PAPIN ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631033132",
            "telephone_number": "314-502-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BAYOU SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "BRONSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-502-1300"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MO",
            "license": "12345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.