Provider Demographics
NPI:1518586932
Name:WEST COUNTY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:WEST COUNTY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NUESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-872-7792
Mailing Address - Street 1:777 CRAIG RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7133
Mailing Address - Country:US
Mailing Address - Phone:314-872-7792
Mailing Address - Fax:
Practice Address - Street 1:777 CRAIG RD STE 130
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7133
Practice Address - Country:US
Practice Address - Phone:314-872-7792
Practice Address - Fax:314-872-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208073205Medicaid