Physician Groups LC
Organization Active NPI Multi-Specialty Clinic/Center · O Fallon, MO
NPI 1609942747 · NPPES record last updated Mar 26, 2008
Key facts
- NPI
- 1609942747
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- PHYSICIAN GROUPS LC
- Practice address
- 3449 Pheasant Meadow Dr
Suite 107
O Fallon, MO 63368-7364 - Phone
- (636) 379-4140
- Fax
- (636) 379-4132
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Raymond P Davidson II, MD
- Title
- President
- Phone
- (314) 286-2028
Other NPIs on the same Medicare enrollment 44
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040220001157 | MO | Part B Supplier - Clinic/Group Practice | 3072421254 |
Receives reassigned benefits from 611 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
3449 Pheasant Meadow Dr
Suite 107
O Fallon, MO 63368-7364
Mailing address
670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644
Other names
- Pheasant Point Physicians
Other providers in O Fallon, MO
- Jennifer Marie Phillips
- Alyssa A Phinney
- Physical Medicine Group, LLC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Management Services of Southern Missouri, LLC
- Nika Pickett
All providers in O Fallon, MO · Multi-Specialty Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.