Provider Demographics
NPI:1669500856
Name:PEDRO C PADILLA M.D.P.C.
Entity Type:Organization
Organization Name:PEDRO C PADILLA M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-528-6844
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0267
Mailing Address - Country:US
Mailing Address - Phone:636-528-6844
Mailing Address - Fax:636-462-2809
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-0267
Practice Address - Country:US
Practice Address - Phone:636-528-6844
Practice Address - Fax:636-462-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201214509Medicaid
MO826343353AOtherRAILROAD MEDICARE
MOA90852Medicare UPIN
MO826343353AOtherRAILROAD MEDICARE
MO000014339Medicare PIN
MO000014338Medicare PIN