Provider Demographics
NPI:1366830572
Name:WUCA-O'FALLON PEDIATRICS, LLC
Entity Type:Organization
Organization Name:WUCA-O'FALLON PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:20 PROGRESS POINT PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-2206
Mailing Address - Country:US
Mailing Address - Phone:636-344-3333
Mailing Address - Fax:
Practice Address - Street 1:20 PROGRESS POINT PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2206
Practice Address - Country:US
Practice Address - Phone:636-344-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty