Primary Care of Bonne Terre LLC

NPI #1962883751 in Bonne Terre, Missouri

Provider Information

NPI Number: 1962883751
Entity Type: Organization
Organization Name: Primary Care of Bonne Terre LLC
Primary Specialty: General Practice
Enumeration Date: Jun 17, 2015
Last Updated: Nov 23, 2015

Practice Location

Address: 527 BENHAM ST
City: Bonne Terre
State: Missouri
ZIP Code: 63628-1205
Phone: (573) 358-9119

Authorized Official

Name: ANDREW J NINICHUCK, MD
Title: OWNER
Phone: (573) 358-9119

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X
General Practice	208D00000X	Primary

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