Provider Demographics
NPI:1639320773
Name:T J MCCAFFREY MD PC
Entity Type:Organization
Organization Name:T J MCCAFFREY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCCAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-5958
Mailing Address - Street 1:755 DUNN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1751
Mailing Address - Country:US
Mailing Address - Phone:314-251-5958
Mailing Address - Fax:314-251-5954
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 6005B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-5958
Practice Address - Fax:314-251-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5B96207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09880Medicare UPIN