Provider Demographics
NPI:1093994642
Name:CELSO F RODRIGUES MD PC
Entity Type:Organization
Organization Name:CELSO F RODRIGUES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CELSO
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-461-2711
Mailing Address - Street 1:2674 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2024
Mailing Address - Country:US
Mailing Address - Phone:636-461-2711
Mailing Address - Fax:636-461-0786
Practice Address - Street 1:2674 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2024
Practice Address - Country:US
Practice Address - Phone:636-461-2711
Practice Address - Fax:636-461-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODB4357OtherRAILROAD MEDICARE
MOH48037Medicare UPIN
MO000014195Medicare PIN