Provider Demographics
NPI:1972567923
Name:INSTITUTE FOR RESEARCH AND EDUCATION IN FAMILY MEDICINE
Entity Type:Organization
Organization Name:INSTITUTE FOR RESEARCH AND EDUCATION IN FAMILY MEDICINE
Other - Org Name:IFM COMMUNITY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-833-4030
Mailing Address - Street 1:5501 DELMAR BLVD STE B560
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3084
Mailing Address - Country:US
Mailing Address - Phone:314-833-4030
Mailing Address - Fax:314-833-4031
Practice Address - Street 1:9417 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2009
Practice Address - Country:US
Practice Address - Phone:314-833-4030
Practice Address - Fax:314-833-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H15207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506012806Medicaid
MO506012806Medicaid