Provider Demographics
NPI:1053341289
Name:PRACTICE MANAGEMENT AFFILIATES CONSULTING INC
Entity type:Organization
Organization Name:PRACTICE MANAGEMENT AFFILIATES CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-939-4200
Mailing Address - Street 1:1600 HERITAGE LNDG
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8489
Mailing Address - Country:US
Mailing Address - Phone:636-939-4200
Mailing Address - Fax:636-939-4204
Practice Address - Street 1:1600 HERITAGE LNDG
Practice Address - Street 2:SUITE 215
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-8489
Practice Address - Country:US
Practice Address - Phone:636-939-4200
Practice Address - Fax:636-939-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505843003Medicaid
MO000013595Medicare PIN