| Organization Name: | PHYSICIAN GROUPS LC |
| NPI Number: | 1710053897 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAYMOND P DAVIDSON (PRESIDENT) |
| Mailing Address: | 1 Dillon Plaza Dr High Ridge |
| State: | MO US |
| Postal Code: | 630492478 |
| Phone Number: | 6366773012 |
| Fax Number: | 6366773174 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 03/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |