Provider Demographics
NPI:1730259888
Name:DOCTORS GROUP , PC
Entity type:Organization
Organization Name:DOCTORS GROUP , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-551-0338
Mailing Address - Street 1:12800 BOENKER LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2438
Mailing Address - Country:US
Mailing Address - Phone:314-551-0338
Mailing Address - Fax:314-551-0336
Practice Address - Street 1:12800 BOENKER LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2438
Practice Address - Country:US
Practice Address - Phone:314-551-0338
Practice Address - Fax:314-551-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014880Medicare PIN
MO000014880Medicare ID - Type Unspecified