Provider Demographics
NPI:1578713269
Name:COMPREHENSIVE MEDICINE, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICINE, INC
Other - Org Name:PREVENTIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-997-5403
Mailing Address - Street 1:1977 SCHUETZ RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3551
Mailing Address - Country:US
Mailing Address - Phone:314-997-5403
Mailing Address - Fax:314-997-6837
Practice Address - Street 1:1977 SCHUETZ RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3551
Practice Address - Country:US
Practice Address - Phone:314-997-5403
Practice Address - Fax:314-997-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P42207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013222Medicare PIN