Provider Demographics
NPI:1609976752
Name:FAMILY MEDICINE OF SOUTH CITY, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF SOUTH CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAHODZIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-4410
Mailing Address - Street 1:3915 WATSON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-644-4410
Mailing Address - Fax:314-646-0054
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:STE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-644-4410
Practice Address - Fax:314-646-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center