Provider Demographics
NPI:1770596884
Name:WARRENTON FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:WARRENTON FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-456-1448
Mailing Address - Street 1:605 E BOONESLICK RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2127
Mailing Address - Country:US
Mailing Address - Phone:636-456-1448
Mailing Address - Fax:636-456-9093
Practice Address - Street 1:605 E BOONESLICK RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2127
Practice Address - Country:US
Practice Address - Phone:636-456-1448
Practice Address - Fax:636-456-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019582261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty