Provider Demographics
NPI:1679520720
Name:CRITICAL CARE MANAGEMENT GROUP, LLC
Entity Type:Organization
Organization Name:CRITICAL CARE MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-921-2250
Mailing Address - Street 1:3533 DUNN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6761
Mailing Address - Country:US
Mailing Address - Phone:314-921-2250
Mailing Address - Fax:
Practice Address - Street 1:3533 DUNN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6761
Practice Address - Country:US
Practice Address - Phone:314-921-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODE1800OtherRR MEDICARE
MO508336500Medicaid
MO000014790Medicare PIN