Provider Demographics
NPI:1104368489
Name:UNITED SKIN SPECIALISTS MISSOURI LTD, PC
Entity Type:Organization
Organization Name:UNITED SKIN SPECIALISTS MISSOURI LTD, PC
Other - Org Name:WEST COUNTY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CRENDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-367-7110
Mailing Address - Street 1:2 CARLSON PKWY N STE 240
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4485
Mailing Address - Country:US
Mailing Address - Phone:636-532-2422
Mailing Address - Fax:636-532-2425
Practice Address - Street 1:1001 CHESTERFIELD PKWY E
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2167
Practice Address - Country:US
Practice Address - Phone:636-532-2422
Practice Address - Fax:636-532-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty