Provider Demographics
NPI:1801919899
Name:W2WLLC
Entity type:Organization
Organization Name:W2WLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-3336
Mailing Address - Street 1:PO BOX 957294
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-7294
Mailing Address - Country:US
Mailing Address - Phone:314-644-3336
Mailing Address - Fax:314-644-5606
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-644-3336
Practice Address - Fax:314-644-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13296Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER