Provider Demographics
NPI:1376702738
Name:FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:TERESSA
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-645-7265
Mailing Address - Street 1:1031 BELLEVUE AVE
Mailing Address - Street 2:SUITE 349
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1818
Mailing Address - Country:US
Mailing Address - Phone:314-645-7265
Mailing Address - Fax:314-645-7578
Practice Address - Street 1:1031 BELLEVUE AVE
Practice Address - Street 2:SUITE 349
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1818
Practice Address - Country:US
Practice Address - Phone:314-645-7265
Practice Address - Fax:314-645-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205710304Medicaid
MO205710304Medicaid
MOMA3396Medicare PIN