Impact Physician Group, Missouri, LLC

NPI #1962971531 in Bridgeton, Missouri

Provider Information

NPI Number: 1962971531
Entity Type: Organization
Organization Name: Impact Physician Group, Missouri, LLC
Primary Specialty: Internal Medicine
Enumeration Date: Nov 13, 2018
Last Updated: Dec 19, 2022

Practice Location

Address: 12380 DE PAUL DR
City: Bridgeton
State: Missouri
ZIP Code: 63044-2511
Phone: (314) 447-9700

Authorized Official

Name: PAUL MILLER
Title: CEO
Phone: (678) 967-5599

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine - Endocrinology, Diabetes & Metabolism — Endocrinology, Diabetes & Metabolism	207RE0101X
Internal Medicine - Gastroenterology — Gastroenterology	207RG0100X
Internal Medicine - Pulmonary Disease — Pulmonary Disease	207RP1001X
Internal Medicine	207R00000X	Primary

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