COMPLEX HEALTHCARE OF DES PERES LLC (NPI# 1104432640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104432640 |
| Entity Type | Organization |
| Organization Name | COMPLEX HEALTHCARE OF DES PERES LLC |
| Practice Address |
1032 Old Des Peres Rd Saint Louis MO 63131-1865 |
| Mailing Address |
6040 Camp Bowie Blvd Ste 24 Fort Worth TX 76116-5602 |
| Practice Telephone | 8177351180 |
| Mailing Telephone | 8177351180 |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2020-09-21 |
| Authorized Official Name | GLENN HERMES (CEO) |
| Authorized Official Telephone | 8176926313 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
Allopathic & Osteopathic Physicians |
| Street Address |
1032 OLD DES PERES RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63131-1865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568097954 | Avalcare Inc | Pharmacy | 10431 Clayton Rd, Saint Louis, MO 63131 | 2020-03-06 |
| 1891331369 | Life Clinic of Mo Dc PC | Chiropractor | 2051 South Lindbergh Blvd, Frontenac, MO 63131 | 2019-11-20 |
| 1447892542 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 30 S Lindbergh Blvd, Saint Louis, MO 63131 | 2019-10-10 |
| 1336797026 | Justa Davis | Dietitian, Registered | 3015 North Ballas, Saint Louis, MO 63131 | 2019-08-27 |
| 1730695362 | Curators of The University of Missouri | Psychologist | 12837 Flushing Meadows Drive, Sutie 220, Town and Country, MO 63131 | 2017-12-19 |
| 1770012031 | Danielle Marie Hargate | Specialist/Technologist | 732 Timber Trail, Frontenac, MO 63131 | 2017-06-08 |
| 1285087429 | Kathryn Parker | Internal Medicine | 1000 Des Peres Rd Ste 300, Saint Louis, MO 63131 | 2016-07-22 |
| 1437524360 | Julie Ann Godefroid | Nurse Practitioner | 1010 Old Des Peres Road, St. Louis, MO 63131 | 2015-12-03 |
| 1073982435 | Rebecca Baum Rainbolt | Social Worker | 12210 Clayton Rd, Saint Louis, MO 63131 | 2015-09-16 |
| 1518217322 | Advanced Anesthesia and Pain Management, LLC | Anesthesiology | 12805 Topping Woods Estate Drive, St. Louis, MO 63131 | 2012-09-19 |
| Find all providers in zip 63131 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598700684 | Raana J Ponstingl | Emergency Medicine | 3635 Vista At Grand Boulevard, Saint Louis, MO 63110 | 2006-06-20 |
| 1154703841 | Preston Mangum Gilbert | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2015-06-18 |
| 1497042055 | Linh Tuong Le | Emergency Medicine | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2011-07-05 |
| 1730342163 | Emergency Physicians of St. Louis, PC | Emergency Medicine | 10010 Kennerly Road, Saint Louis, MO 63128 | 2008-07-07 |
| 1306027909 | Chad Michael Ronholm | Emergency Medicine | 520 S Elm Ave, Saint Louis, MO 63119-3845 | 2007-11-25 |
| 1154432854 | Laura J Steines | Emergency Medicine | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2006-08-31 |
| 1659307437 | Joe V Baldwin | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2006-06-24 |
| 1578599254 | James R Mcadam | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2006-06-24 |
| 1750327250 | Federico J Jimenez Jr. | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2006-06-22 |
| 1649223561 | Annu A. Terkonda | Emergency Medicine | 3555 Sunset Office Dr, Ste. C, Saint Louis, MO 63127-1015 | 2006-05-19 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63131 |
Please comment or provide details below to improve the information on COMPLEX HEALTHCARE OF DES PERES LLC.
| 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.