FENTON FAMILY PRACTICE, LLC - NPI 1356493811

Q: What is the provider's specialty?

The provider's specialty is Specialist with taxonomy code 174400000X.

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About Fenton Family Practice, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FENTON FAMILY PRACTICE, LLC (NPI 1356493811) is a healthcare organization registered as a specialist in Fenton, Missouri and active in the NPI registry since January 2007. The organization lists Brenda Lynn Buckley, Doctor, as its authorized official.

NPPES Registry Identity

NPI1356493811

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameFENTON FAMILY PRACTICE, LLC

Location Address1747 SMIZER STATION RD, SUITE 5Fenton, MO 63026-2784

Mailing Address1747 Smizer Station Rd, Suite 5Fenton, MO 63026-2784 · (636) 529-7000 · Fax (636) 529-7003

Phone(636) 529-7000

Fax(636) 529-7003

Organization SubpartNo

Authorized OfficialBrenda Lynn BuckleyDoctor · (636) 529-7000

Enumeration DateJanuary 17, 2007

Last NPPES UpdateSeptember 19, 2013

✔ NPI 1356493811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in MO · 115447

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

1747 SMIZER STATION RD, Fenton, MO 63026

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Other Identifiers 3

Medicare ID-Type Unspecified000095305MO

Medicaid205692908MO

Medicare UPINH48978MO

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP