Provider Demographics
NPI:1669290623
Name:ROMO DIRECT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:ROMO DIRECT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HUHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-973-6261
Mailing Address - Street 1:1028 S. BISHOP AVE
Mailing Address - Street 2:PMB 201
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-995-2213
Mailing Address - Fax:573-240-9752
Practice Address - Street 1:706 S BISHOP AVE STE A
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4333
Practice Address - Country:US
Practice Address - Phone:573-995-2213
Practice Address - Fax:573-240-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty