Provider Demographics
NPI:1902197767
Name:INTERNAL MEDICINE OF KIRKWOOD, LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF KIRKWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN NETWORK
Authorized Official - Prefix:MR
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 1:232 S WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3406
Mailing Address - Country:US
Mailing Address - Phone:636-685-7804
Mailing Address - Fax:314-576-2434
Practice Address - Street 1:461 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6119
Practice Address - Country:US
Practice Address - Phone:314-965-1513
Practice Address - Fax:314-965-1063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKES MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty