Provider Demographics
NPI:1245542042
Name:J.C. REDINGTON, MD INC
Entity type:Organization
Organization Name:J.C. REDINGTON, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-781-4840
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1854
Mailing Address - Country:US
Mailing Address - Phone:314-781-4840
Mailing Address - Fax:314-781-0285
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:STE 105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-781-4840
Practice Address - Fax:314-781-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO24995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10026Medicare UPIN