Provider Demographics
NPI:1407018781
Name:DRS PICHET & MEECHAI
Entity Type:Organization
Organization Name:DRS PICHET & MEECHAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-939-8648
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:509 HAMACHER ST, STE 200B
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-0170
Mailing Address - Country:US
Mailing Address - Phone:618-939-8648
Mailing Address - Fax:618-939-8650
Practice Address - Street 1:509 HAMACHER ST STE 200B
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1592
Practice Address - Country:US
Practice Address - Phone:618-939-8648
Practice Address - Fax:618-939-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty