Provider Demographics
NPI:1740969120
Name:GENERATION CLINICAL PARTNERS ACO, LLC
Entity type:Organization
Organization Name:GENERATION CLINICAL PARTNERS ACO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-925-0903
Mailing Address - Street 1:10426 BAUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1905
Mailing Address - Country:US
Mailing Address - Phone:314-925-0903
Mailing Address - Fax:
Practice Address - Street 1:723 S LACLEDE STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4911
Practice Address - Country:US
Practice Address - Phone:314-925-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATION CLINICAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty