Provider Demographics
NPI:1467616722
Name:INTERNAL MEDICINE OF WEST COUNTY, LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF WEST COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-576-2490
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-2490
Mailing Address - Fax:314-576-2334
Practice Address - Street 1:14897 CLAYTON RD
Practice Address - Street 2:STE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7887
Practice Address - Country:US
Practice Address - Phone:636-227-3222
Practice Address - Fax:636-227-1178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-16
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1468Medicare PIN