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NPI Verification

National Provider Identifier: 1962971531

Impact Physician Group, Missouri, LLC

Organization

Primary Specialty

Internal Medicine

Code: 207R00000X

All Specialties (4)

Internal Medicine, Endocrinology, Diabetes & Metabolism

Code: 207RE0101X

Internal Medicine, Gastroenterology

Code: 207RG0100X

Internal Medicine, Pulmonary Disease

Code: 207RP1001X

Internal Medicine

Code: 207R00000X

Primary

Practice Address

12380 DE PAUL DR

BRIDGETON, MO 630442511

Phone: 314-447-9700

NPI Enumeration Date

November 13, 2018

NPI Number

1962971531

Data sourced from the official CMS NPPES Registry. This information is provided by the Centers for Medicare & Medicaid Services and is updated regularly.

View on CMS NPPES Registry