Provider Demographics
NPI:1558630053
Name:BEV FINGERHOOD, LTD
Entity Type:Organization
Organization Name:BEV FINGERHOOD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGERHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-916-5575
Mailing Address - Street 1:2127 BLUESTONE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6709
Mailing Address - Country:US
Mailing Address - Phone:636-916-5575
Mailing Address - Fax:636-916-0387
Practice Address - Street 1:2127 BLUESTONE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6709
Practice Address - Country:US
Practice Address - Phone:636-916-5575
Practice Address - Fax:636-916-0387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEV FINGERHOOD, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD100875261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care