Provider Demographics
NPI:1871762385
Name:DOCTOR'S CLINICAL GROUP
Entity type:Organization
Organization Name:DOCTOR'S CLINICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:POETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-291-0505
Mailing Address - Street 1:PO BOX 790379
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0379
Mailing Address - Country:US
Mailing Address - Phone:314-291-0505
Mailing Address - Fax:314-291-0747
Practice Address - Street 1:12255 DEPAUL DRIVE SUITE 865
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-291-0505
Practice Address - Fax:314-291-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29351207Q00000X
MO152467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004255603OtherAETNA
MO240407908Medicaid
MO250759OtherHARMONY
MO3065209001OtherCIGNA
MO489409703OtherMERCYCARE PLUS
MOD92011OtherHUMANA
MO080130617OtherMEDICARE RAILROAD
MO103753OtherHEALTHLINK
MO123036OtherGHP
MO489409703OtherCOMMUNITY CARE
MO01-00207OtherUNITED HEALTH CARE
MO100805OtherANTHEM BC/BS
MO100805OtherBC/BS
MO2064OtherHEALTHCARE USA
MO77072OtherWELLCARE
MOD92011OtherEXCLUSIVE CHOICE
MO1013577OtherCARE PARTNERS
MO1940001OtherPARTNERS
MO103753OtherHEALTHLINK
MO100805OtherBC/BS
MO250759OtherHARMONY