Iconic Services Inc

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

ICONIC SERVICES INC

Practice address

4625 Lindell Blvd Ste 200
Saint Louis, MO 63108-3729

Phone

(314) 437-8932

Fax

(888) 749-2228

NPI assigned

May 21, 2018

Last updated

May 21, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christine B Cordero

Title

Manager

Phone

(314) 437-8932

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526860800000",
    "number": "1750872354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083729",
            "telephone_number": "314-437-8932",
            "fax_number": "888-749-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 LINDELL BLVD STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083729",
            "telephone_number": "314-437-8932",
            "fax_number": "888-749-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2018-05-21",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-437-8932"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Family Medicine) Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Sports Medicine (Family Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.