Provider Demographics
NPI:1033194386
Name:DR. WIT INTERNAL MEDICINE PROF GERIATRIC CARE
Entity Type:Organization
Organization Name:DR. WIT INTERNAL MEDICINE PROF GERIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-367-2727
Mailing Address - Street 1:7137 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4417
Mailing Address - Country:US
Mailing Address - Phone:314-721-0675
Mailing Address - Fax:314-721-2830
Practice Address - Street 1:5621 DELMAR BLVD
Practice Address - Street 2:#105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2656
Practice Address - Country:US
Practice Address - Phone:314-367-2727
Practice Address - Fax:314-367-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505084103Medicaid
CG9649OtherRAILROAD MEDICARE
MO505084103Medicaid
CG9649Medicare PIN