Provider Demographics
NPI:1326464298
Name:DELMAR PRIMARY CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:DELMAR PRIMARY CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-833-3437
Mailing Address - Street 1:5621 DELMAR BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2656
Mailing Address - Country:US
Mailing Address - Phone:314-833-3437
Mailing Address - Fax:314-833-3102
Practice Address - Street 1:5621 DELMAR BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112
Practice Address - Country:US
Practice Address - Phone:314-833-3437
Practice Address - Fax:314-833-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013940261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1568626349OtherNPI