Provider Demographics
NPI:1245455880
Name:ROWDEN FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:ROWDEN FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:314-307-2727
Mailing Address - Street 1:738 PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-1647
Mailing Address - Country:US
Mailing Address - Phone:314-307-2727
Mailing Address - Fax:
Practice Address - Street 1:12 JEFFERSON SQ
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1031
Practice Address - Country:US
Practice Address - Phone:636-586-6685
Practice Address - Fax:636-586-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH64231Medicare UPIN
MO13689Medicare ID - Type Unspecified