Provider Demographics
NPI:1700182318
Name:ROWDEN FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:ROWDEN FAMILY MEDICINE PC
Other - Org Name:FAMILY FIRST HEALTHCARE OF DESOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-377-7800
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0143
Mailing Address - Country:US
Mailing Address - Phone:636-337-7800
Mailing Address - Fax:
Practice Address - Street 1:400B W LUEKING DR
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1042
Practice Address - Country:US
Practice Address - Phone:636-337-7800
Practice Address - Fax:573-438-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
H64231Medicare UPIN
MO793818Medicare Oscar/Certification