Provider Demographics
NPI:1891962072
Name:TED C. VARGAS, INC.
Entity Type:Organization
Organization Name:TED C. VARGAS, INC.
Other - Org Name:PACIFIC MEDCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-271-3500
Mailing Address - Street 1:319 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1505
Mailing Address - Country:US
Mailing Address - Phone:636-271-3500
Mailing Address - Fax:636-271-9955
Practice Address - Street 1:319 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1505
Practice Address - Country:US
Practice Address - Phone:636-271-3500
Practice Address - Fax:636-271-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK92006OtherEXCLUSIVE CHOICE
MO101254OtherHEALTHLINK
MO18297OtherANTHEM
MO5523OtherGROUP HEALTH PLAN
MO100922001OtherUNITED HEALTH CARE
MO200864908Medicaid
MO2052OtherHEALTHCARE USA
MO18297OtherANTHEM