Provider Demographics
NPI:1689072324
Name:LADUE INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:LADUE INTERNAL MEDICINE, 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:636-685-7804
Mailing Address - Street 1:8857B LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2058
Mailing Address - Country:US
Mailing Address - Phone:314-682-3626
Mailing Address - Fax:314-590-5954
Practice Address - Street 1:8857B LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2058
Practice Address - Country:US
Practice Address - Phone:314-682-3626
Practice Address - Fax:314-590-5954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty