Provider Demographics
NPI:1417079377
Name:MEDCARE PHYSICIAN LLC
Entity Type:Organization
Organization Name:MEDCARE PHYSICIAN LLC
Other - Org Name:VICTORIA L ALLEN DO
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-225-2273
Mailing Address - Street 1:2117 BENTLEY PLAZA
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026
Mailing Address - Country:US
Mailing Address - Phone:636-225-2273
Mailing Address - Fax:636-225-2275
Practice Address - Street 1:2117 BENTLEY PLAZA
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:636-225-2273
Practice Address - Fax:636-225-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7P15207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5538116OtherAETNA
116943OtherBCBS
205957OtherHEALTHLINK
0105047OtherUHC
E96534OtherMERCY
52993OtherGHP
205957OtherHEALTHLINK
E96534OtherMERCY