Provider Demographics
NPI:1144564196
Name:SOUTH COUNTY ENDOCRINOLOGY AND OBESITY MEDICINE LLC
Entity type:Organization
Organization Name:SOUTH COUNTY ENDOCRINOLOGY AND OBESITY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BHARATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-236-5820
Mailing Address - Street 1:12900 TESSON FERRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3002
Mailing Address - Country:US
Mailing Address - Phone:314-843-4848
Mailing Address - Fax:
Practice Address - Street 1:12900 TESSON FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3002
Practice Address - Country:US
Practice Address - Phone:314-843-4848
Practice Address - Fax:866-510-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001005643261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty