Provider Demographics
NPI:1477867844
Name:DRX - EAST MISSOURI PROVIDERS, P.C.
Entity type:Organization
Organization Name:DRX - EAST MISSOURI PROVIDERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINDECUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-335-2900
Mailing Address - Street 1:1610 N KINGSHIGHWAY ST
Mailing Address - Street 2:THIRD FLOOR, SUITE 301
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2196
Mailing Address - Country:US
Mailing Address - Phone:573-275-8067
Mailing Address - Fax:573-803-4061
Practice Address - Street 1:465 S MOUNT AUBURN RD STE 103
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4900
Practice Address - Country:US
Practice Address - Phone:573-335-2900
Practice Address - Fax:573-335-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MO261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty