Provider Demographics
NPI:1467551457
Name:PATRICK H DURBIN M.D.P.C.
Entity Type:Organization
Organization Name:PATRICK H DURBIN M.D.P.C.
Other - Org Name:SENIOR HEALTH CENTER AT ST LOUIS HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-7000
Mailing Address - Street 1:6901 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109
Mailing Address - Country:US
Mailing Address - Phone:314-644-7000
Mailing Address - Fax:314-644-7101
Practice Address - Street 1:6901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109
Practice Address - Country:US
Practice Address - Phone:314-644-7000
Practice Address - Fax:314-644-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202982955Medicaid
MO900614156Medicare ID - Type Unspecified
MO202982955Medicaid