Provider Demographics
NPI:1548592421
Name:BRICCIO S. CADIZ, MD PC
Entity Type:Organization
Organization Name:BRICCIO S. CADIZ, MD PC
Other - Org Name:COUNTY WIDE INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICCIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:CADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-7903
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-7237
Mailing Address - Country:US
Mailing Address - Phone:636-937-7903
Mailing Address - Fax:636-937-7602
Practice Address - Street 1:1447 HIGHWAY 61
Practice Address - Street 2:SUITE B
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4109
Practice Address - Country:US
Practice Address - Phone:636-937-7903
Practice Address - Fax:636-937-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208171819Medicaid
MO208171819Medicaid