Provider Demographics
NPI:1023048907
Name:GENERATIONS FAMILY MEDICINE PC
Entity type:Organization
Organization Name:GENERATIONS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-781-4922
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1846
Mailing Address - Country:US
Mailing Address - Phone:314-781-4922
Mailing Address - Fax:314-645-0158
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1846
Practice Address - Country:US
Practice Address - Phone:314-781-4922
Practice Address - Fax:314-645-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509156709Medicaid
MO509156709Medicaid
MO000014187Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER