Provider Demographics
NPI:1639497290
Name:JOSEPH A. MUCCINI M.D. LLC
Entity Type:Organization
Organization Name:JOSEPH A. MUCCINI M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MUCCINI
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-0600
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-878-0600
Mailing Address - Fax:314-878-0602
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 475
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-878-0600
Practice Address - Fax:314-878-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG71268Medicare UPIN
MO000094403Medicare PIN