Provider Demographics
NPI:1477867034
Name:MD2U MISSOURI LLC
Entity Type:Organization
Organization Name:MD2U MISSOURI LLC
Other - Org Name:MD2U DOCTORS WHO MAKE HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BENFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-327-9100
Mailing Address - Street 1:105 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1525
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:502-618-4990
Practice Address - Street 1:111 W PORT PLZ
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3011
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:502-618-4990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD2U MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care