Provider Demographics
NPI:1497874119
Name:LAMBROU, THYMIOS P (MD)
Entity Type:Individual
Prefix:
First Name:THYMIOS
Middle Name:P
Last Name:LAMBROU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SCOTT CITY
Other - Middle Name:MEDICAL
Other - Last Name:CLINIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1337
Mailing Address - Country:US
Mailing Address - Phone:573-264-0042
Mailing Address - Fax:573-264-0087
Practice Address - Street 1:2102 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1337
Practice Address - Country:US
Practice Address - Phone:573-264-0042
Practice Address - Fax:573-264-0087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MOR6C14207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263942Medicare Oscar/Certification
A11140Medicare UPIN
MO263891Medicare Oscar/Certification
A11140Medicare UPIN