Provider Demographics
NPI:1568592483
Name:DRAVES FAMILY PRACTICE
Entity Type:Organization
Organization Name:DRAVES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:DRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-2700
Mailing Address - Street 1:1471 US HWY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4109
Mailing Address - Country:US
Mailing Address - Phone:636-937-2700
Mailing Address - Fax:636-937-8666
Practice Address - Street 1:1471 US HWY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4109
Practice Address - Country:US
Practice Address - Phone:636-937-2700
Practice Address - Fax:636-937-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202387007Medicaid
MO208290403Medicaid
MO425251600Medicaid
MOP28639Medicare UPIN
MO000005635Medicare ID - Type Unspecified
MOG44087Medicare UPIN
MO425251600Medicaid
MO990001327Medicare PIN
MO000080940Medicare ID - Type Unspecified
MO208290403Medicaid