Provider Demographics
NPI:1679939128
Name:FENTON FAMILY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:FENTON FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-685-7840
Mailing Address - Street 1:774 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7758
Mailing Address - Country:US
Mailing Address - Phone:636-685-7804
Mailing Address - Fax:314-336-5205
Practice Address - Street 1:774 GRAVOIS BLUFFS BLVD STE B
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7758
Practice Address - Country:US
Practice Address - Phone:636-685-7734
Practice Address - Fax:314-590-5922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty