MR. ROBERT FRED VANDEBORNE (NPI# 1053864835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053864835 |
| Entity Type | Individual |
| Full Name | MR. ROBERT FRED VANDEBORNE |
| Practice Address |
12647 Olive Blvd Suite 600 Saint Louis MO 63141-6393 |
| Practice Telephone | 8003253982 |
| Practice Fax Number | 8776859880 |
| Mailing Telephone | 8003253982 |
| Mailing Fax Number | 8776859880 |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247100000X | Radiologic Technologist | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
12647 OLIVE BLVD SUITE 600 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-6393 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972506673 | Paul F. Howard | Internal Medicine | 12647 Olive Blvd, Ste 600, Saint Louis, MO 63141-6345 | 2005-05-27 |
| 1548734353 | Apiphanie Lujan | Counselor | 12647 Olive Blvd, Saint Louis, MO 63141-6393 | 2019-01-15 |
| 1881115624 | Trenise Lynette Brown | Social Worker | 12647 Olive Blvd, Saint Louis, MO 63141-6393 | 2017-07-01 |
| 1336676006 | Amanda Brown Kidwell | Counselor | 12647 Olive Blvd, Ste 200, Saint Louis, MO 63141-6393 | 2017-05-12 |
| 1346776291 | Jessica Brown | Counselor | 12647 Olive Blvd, Saint Louis, MO 63141-6393 | 2017-05-11 |
| 1356877195 | Anne Tichacek | Social Worker | 12647 Olive Blvd, Saint Louis, MO 63141-6393 | 2017-05-11 |
| 1689100901 | Jenny Deutsch | Social Worker | 12647 Olive Blvd, Suite 200, Saint Louis, MO 63141-6393 | 2017-05-05 |
| 1932635299 | Qiyun Gao | Social Worker | 12647 Olive Blvd, Suite 200, Saint Louis, MO 63141-6393 | 2017-05-05 |
| 1831625169 | Lisa M Flamion | Counselor | 12647 Olive Blvd, Suite 200, Saint Louis, MO 63141-6393 | 2017-05-05 |
| 1396271664 | Jennifer L. Brown | Social Worker | 12647 Olive Blvd, Suite 200, Saint Louis, MO 63141-6393 | 2017-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 247100000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164661179 | Mary Ellen Ash | Radiologic Technologist | 407 S Park Ave, Saint Louis, MO 63119-4151 | 2009-02-13 |
| 1689855421 | Linda Kay Goddard | Radiologic Technologist | 7804 Clevedon St, Saint Louis, MO 63123-3822 | 2007-11-20 |
| 1659496636 | Nancy Schultheis | Radiologic Technologist | 9856 Scottdale Dr, Saint Louis, MO 63136-1955 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306225412 | Joseph Parks | Radiologic Technologist | 412 Treetop Village Ct, Ballwin, MO 63021-7456 | 2015-05-21 |
| 1891984951 | Mid-america X-ray LLC | Radiologic Technologist | 1711 Taylor St., Lexington, MO 64067-1153 | 2007-10-15 |
| 1831301639 | Dan T Sullivan | Radiologic Technologist | 3780 E Pond Apple Dr, Springfield, MO 65809-4147 | 2007-05-04 |
| 1831124478 | Kathleen A Rogers | Radiologic Technologist | 5273 S Aaron Ave, Springfield, MO 65810-2879 | 2006-07-12 |
| 1295279636 | Cassie Elrod | Radiologic Technologist | 800 Hospital Dr, Columbia, MO 65201-5275 | 2016-12-04 |
| 1396155636 | Heartland Regional Medical Center | Radiologic Technologist | 8880 Ne 82nd Ter, Kansas City, MO 64158-1313 | 2014-05-07 |
| 1770904393 | Heartland Regional Medical Center | Radiologic Technologist | 6301 N Lucerne Ave, Kansas City, MO 64151-3105 | 2013-12-27 |
| 1295166445 | Daniel Taylor | Radiologic Technologist | 408 Washington Ave, West Plains, MO 65775-3432 | 2013-12-12 |
| 1376974386 | Jeanne Maliwat | Radiologic Technologist | 4801 E Linwood Blvd, Kansas City, MO 64128-2226 | 2013-12-02 |
| 1891034229 | Qmb Radiology LLC | Radiologic Technologist | 35629 Highway 72, Salem, MO 65560-7217 | 2013-02-05 |
| Find all providers with the same taxonomy | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.