Provider Demographics
NPI:1902122211
Name:INTENSIVIST GROUP OF MISSOURI INC
Entity Type:Organization
Organization Name:INTENSIVIST GROUP OF MISSOURI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-344-0543
Mailing Address - Street 1:830 W IL ROUTE 22
Mailing Address - Street 2:SUITE 50
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2560
Mailing Address - Country:US
Mailing Address - Phone:866-344-0543
Mailing Address - Fax:866-344-3934
Practice Address - Street 1:1015 BOWLES AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2394
Practice Address - Country:US
Practice Address - Phone:866-344-0543
Practice Address - Fax:866-344-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty