Provider Demographics
NPI:1538860267
Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF WEST COUNTY, LLC
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF WEST COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGLIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-394-1923
Mailing Address - Street 1:2121 BARRETT STATION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1606
Mailing Address - Country:US
Mailing Address - Phone:314-394-1923
Mailing Address - Fax:314-394-1953
Practice Address - Street 1:5650 MEXICO RD STE 2
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1696
Practice Address - Country:US
Practice Address - Phone:636-875-1270
Practice Address - Fax:636-875-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty