Provider Demographics
NPI:1609983055
Name:WEST END INTERNAL MEDICINE
Entity type:Organization
Organization Name:WEST END INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:NOVELLA
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-2766
Mailing Address - Street 1:5585 PERSHING AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112
Mailing Address - Country:US
Mailing Address - Phone:314-367-2766
Mailing Address - Fax:314-454-1336
Practice Address - Street 1:5585 PERSHING AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112
Practice Address - Country:US
Practice Address - Phone:314-367-2766
Practice Address - Fax:314-454-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORC400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13908Medicare UPIN