Provider Demographics
NPI:1043476385
Name:RICHARD E PARCINSKI DO FCCP LLC
Entity Type:Organization
Organization Name:RICHARD E PARCINSKI DO FCCP LLC
Other - Org Name:RICHARD E PARCINSKI DO FCCP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PARCINSKI
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:636-936-1809
Mailing Address - Street 1:6 JUNGERMANN CIRCLE
Mailing Address - Street 2:STE 121
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1618
Mailing Address - Country:US
Mailing Address - Phone:636-936-1809
Mailing Address - Fax:636-936-3655
Practice Address - Street 1:6 JUNGERMANN CIRCLE
Practice Address - Street 2:STE 121
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1618
Practice Address - Country:US
Practice Address - Phone:636-936-1809
Practice Address - Fax:636-936-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24776850Medicaid
MOB40257Medicare UPIN
MO1323Medicare PIN