NPIMap

Organization Active NPI

La Clinica

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1386841328
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LA CLINICA
Practice address
3646 Fairview Ave
Saint Louis, MO 63116-4747
Phone
(314) 664-5564
Fax
(314) 773-0709
NPI assigned
Jul 2, 2007
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
David C Campbell, M.D. M.ED.
Title
Executive Director
Phone
(314) 664-5565

Specialties & licenses 1

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

Addresses

Primary practice location

3646 Fairview Ave
Saint Louis, MO 63116-4747

Mailing address

3646 Fairview Ave
Saint Louis, MO 63116-4747
Phone (314) 664-5564

National Provider Directory

National Provider Directory
Tax ID family
La Clinica3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386841328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3646 FAIRVIEW AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631164747",
            "telephone_number": "314-664-5564",
            "fax_number": "314-773-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 FAIRVIEW AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631164747",
            "telephone_number": "314-664-5564",
            "fax_number": "314-773-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-664-5565",
        "authorized_official_credential": "M.D. M.ED."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family 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 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.