MERCY CLINIC EAST COMMUNITIES (NPI# 1164857397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1164857397 |
Entity Type | Organization |
Organization Name | MERCY CLINIC EAST COMMUNITIES |
Other Organization Name | MERCY CLINIC CONVENIENT CARE |
Practice Address |
16555 Manchester Rd Ste 110 Wildwood MO 63040-1220 |
Practice Telephone | 6364053155 |
Practice Fax Number | 6364053162 |
Mailing Telephone | 6364053155 |
Mailing Fax Number | 6364053162 |
Enumeration Date | 2013-09-06 |
Last Update Date | 2018-03-17 |
Authorized Official Name | DR. JOHN W. HUBERT (PRESIDENT) |
Authorized Official Telephone | 3142516000 |
Authorized Official Credential | M.D. |
Is Organization Subpart | Y |
Parent Organization Name | MERCY HEALTH EAST COMMUNITIES |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MO | 1164857397 | 05 |
Other Name | Type Code |
---|---|
Mercy Clinic Convenient Care | Other Name - Individual/Organization |
Address | Telephone Number | Fax Number |
---|---|---|
4525 Mid Rivers Mall Dr Ste 10, Cottleville, MO 633762820 | 6362293350 | 6362293355 |
901 Patients First Dr Ste 1200, Washington, MO 630904700 | 6363901777 | 6363901778 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720635329 | Mercy Clinic East Communities | Family Medicine | 10004 Kennerly Rd Ste 395b, Saint Louis, MO 63128-2190 | 2019-08-20 |
1235493776 | Mercy Clinic East Communities | Clinic/Center | 125 N Old Highway 66, Bourbon, MO 65441-6298 | 2012-06-29 |
1700370061 | Mercy Clinic East Communities | Internal Medicine | 15945 Clayton Rd Ste 310, Ballwin, MO 63011-2493 | 2018-06-20 |
1285998724 | Mercy Clinic East Communities | Clinic/Center | 301 Theresa St, Cuba, MO 65453-1636 | 2012-06-29 |
1467716928 | Mercy Clinic East Communities | Clinic/Center | 101 Progress Pkwy, Sullivan, MO 63080-2359 | 2012-06-29 |
1619231164 | Mercy Clinic East Communities | Clinic/Center | 520 Pine St, Steelville, MO 65565-6041 | 2012-06-29 |
1043574940 | Mercy Clinic East Communities | Allergy & Immunology | 615 S New Ballas Rd, Administration Building, 5th Floor, Saint Louis, MO 63141-8221 | 2012-06-26 |
1073739041 | Mercy Clinic East Communities | Family Medicine | 615 S New Ballas Rd, Administrative Building, 5th Floor, Saint Louis, MO 63141-8221 | 2007-04-18 |
1851335228 | Mercy Clinic East Communities | Family Medicine | 615 S New Ballas Rd, Administration Building, 5th Floor, Saint Louis, MO 63141-8221 | 2006-06-16 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | MERCY CLINIC EAST COMMUNITIES | 645 Maryville Centre Dr, Saint Louis, MO 63141-5855 |
Street Address |
16555 MANCHESTER RD STE 110 |
City | WILDWOOD |
State | MO |
Zip Code | 63040-1220 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619332608 | Tonnya Marie Taggart | Nurse Practitioner | 16555 Manchester Rd Ste 110, Wildwood, MO 63040 | 2015-12-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154959336 | Jacquelyn M Mellis | Social Worker | 2634 Hwy 109, Suite E, Wildwood, MO 63040 | 2020-04-01 |
1710359484 | Dierbergs Town Center Pharmacy | Pharmacy | 2460 Taylor Road, Wildwood, MO 63040 | 2015-10-21 |
1295175057 | Devin Willis | Family Medicine | 16555 Manchester Rd Ste 100, Wildwood, MO 63040 | 2013-06-26 |
1265748248 | Mary K Bland | Speech-Language Pathologist | 251 Plaza Dr, Wildwood, MO 63040 | 2010-08-27 |
1871726067 | Wildwood Internal Medicine, PC | Internal Medicine | 16759 Main Street, Suite 203, Wildwood, MO 63040 | 2009-09-03 |
1730274853 | Seth P Freedman | Dentist | 16920 Manchester Road, Wildwood, MO 63040 | 2006-10-04 |
1477927556 | Forefront Dermatology, S.c. | Dermatology | 16516 Manchester Rd, Wildwood, MO 63040 | 2015-11-30 |
1881953784 | Glennia J Chitwood | Chiropractor | 16925 Manchester Rd, Suite 1, Wildwood, MO 63040 | 2012-05-11 |
1649363888 | Michael Paul Van Horenbeeck | Chiropractor | 16917 Manchester Rd, Wildwood, MO 63040 | 2006-10-02 |
1699314880 | Lauren Alison Medina | Chiropractor | 17197 New College Ave, Wildwood, MO 63040-1100 | 2020-01-05 |
Find all providers in zip 63040 |
Taxonomy Code | 261QM1300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Multi-Specialty |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922575802 | Lakewood Ccl, LLC | Clinic/Center | 5571 E Sr 44 Ste 501, Wildwood, FL 34785-8282 | 2018-10-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023629458 | Palm Valley Health LLC | Clinic/Center | 1095 Nooning Tree Dr, Chesterfield, MO 63017-2468 | 2020-08-10 |
1477175594 | Confident American English, LLC | Clinic/Center | 1190 Jefferson St Ste 103a, Washington, MO 63090-4443 | 2020-05-12 |
1619513215 | Southeast Missouri Health Network | Clinic/Center | 835 W Murray Ln, Sikeston, MO 63801-4056 | 2019-11-19 |
1275014953 | Arch Pediatrics LLC | Clinic/Center | 3844 S Lindbergh Blvd Ste 216, Saint Louis, MO 63127-1369 | 2018-08-22 |
1174015515 | Washington University Physicians In Illinois, Inc | Clinic/Center | 4511 Forest Park Ave, Saint Louis, MO 63108-2138 | 2018-06-01 |
1164921300 | Texas County Memorial Hospital | Clinic/Center | 1333 S Sam Houston Blvd Ste A, Houston, MO 65483 | 2018-02-02 |
1053822650 | Edge Medical Services Inc. | Clinic/Center | 105 W 34th St Apt 2, Kansas City, MO 64111-1677 | 2017-10-23 |
1932618394 | United Physicians Group, LLC | Clinic/Center | 14825 N Outer 40 Rd Ste 365, Chesterfield, MO 63017-2152 | 2017-09-28 |
1073022000 | Fairview Heights Medical Group Sc | Clinic/Center | 670 Mason Ridge Center Dr Ste 300, Saint Louis, MO 63141-8573 | 2017-09-21 |
1013433762 | Elevating Care Clinic, LLC | Clinic/Center | 2340 E. Meyer Blvd, 208, Kansas City, MO 64132-1105 | 2017-08-15 |
Find all providers with the same taxonomy |
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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.