| Organization Name: | SOUTH COUNTY INTERNAL MEDICINE PHYSICIANS, LLC |
| NPI Number: | 1134352396 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RATAN K NALLAMOTHU (PHYSICIAN) |
| Mailing Address: | 1479 Highway 61 Suite A Festus |
| State: | MO US |
| Postal Code: | 630284109 |
| Phone Number: | 6365796148 |
| Fax Number: | 8887566714 |
| NPI Enumeration Date: | 09/03/2009 |
| NPI Last Update Date: | 09/03/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2009008003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |