Provider Demographics
NPI:1760611081
Name:SOUTH COUNTY COMPREHENSIVE CARE LLC
Entity Type:Organization
Organization Name:SOUTH COUNTY COMPREHENSIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHATAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-458-7403
Mailing Address - Street 1:9911 KENNERLY RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2700
Mailing Address - Country:US
Mailing Address - Phone:314-458-7403
Mailing Address - Fax:
Practice Address - Street 1:9911 KENNERLY RD STE C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2700
Practice Address - Country:US
Practice Address - Phone:314-458-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty