Provider Demographics
NPI:1992026538
Name:BARBARA MCDOWELL, LLC
Entity Type:Organization
Organization Name:BARBARA MCDOWELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-680-1177
Mailing Address - Street 1:6290 RONALD REAGAN DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2667
Mailing Address - Country:US
Mailing Address - Phone:314-680-1177
Mailing Address - Fax:636-230-0421
Practice Address - Street 1:6290 RONALD REAGAN DR
Practice Address - Street 2:SUITE 222
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2667
Practice Address - Country:US
Practice Address - Phone:314-680-1177
Practice Address - Fax:636-230-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN052085364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4246752221Medicaid
890000994OtherFEDERAL MEDICARE
156059OtherANTHEM BLUE CROSS AND BLUE SHIELD
MO4246752221Medicaid