Provider Demographics
NPI:1770739419
Name:JOHN S. FARRELL, M.D., P.C.
Entity type:Organization
Organization Name:JOHN S. FARRELL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-6966
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 584A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6966
Mailing Address - Fax:314-251-6632
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 584A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6966
Practice Address - Fax:314-251-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5636207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200162204Medicaid
MO2900001OtherUHC
MO7014353OtherESSENCE
MO21591OtherBLUE CROSS BLUE SHIELD
MO7014353OtherESSENCE