FALLON H MAYLACK (NPI# 1184642993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184642993 |
| Entity Type | Individual |
| Full Name | FALLON H MAYLACK |
| Credential | MD |
| Practice Address |
12255 De Paul Dr Ste 845 Bridgeton MO 63044-2510 |
| Mailing Address |
Po Box 23340 Saint Louis MO 63156-3340 |
| Practice Telephone | 3148846320 |
| Practice Fax Number | 3148846321 |
| Mailing Telephone | 3148846320 |
| Mailing Fax Number | 3148846321 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-02-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | R5E50 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 207746702 | 05 |
| Street Address |
12255 DE PAUL DR STE 845 |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044-2510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588667497 | Maria Mcfarland | Podiatrist | 12255 De Paul Dr, Suite 500, Bridgeton, MO 63044-2510 | 2005-05-24 |
| 1760846414 | Rachel Heft | Nurse Practitioner | 12255 De Paul Dr, Suite 200, Bridgeton, MO 63044-2510 | 2016-04-08 |
| 1174983878 | Angela R Berry | Nurse Practitioner | 12255 De Paul Dr, Ste 700, Bridgeton, MO 63044-2510 | 2016-02-24 |
| 1922478726 | Darcy L Daniels | Nurse Practitioner | 12255 De Paul Dr, Suite 500, Bridgeton, MO 63044 | 2015-10-06 |
| 1821481474 | Lindsey Rae Duncan | Nurse Practitioner | 12255 De Paul Dr, Suite 865, Bridgeton, MO 63044-2510 | 2015-03-06 |
| 1376884916 | Comfort & Joy Home Health Care Agency | Home Health | 12255 De Paul Dr, Suite 45n, Bridgeton, MO 63044-2510 | 2013-03-06 |
| 1457604878 | Mary F Hans | Nurse Practitioner | 12255 De Paul Dr, 320, Bridgeton, MO 63044-2510 | 2012-10-23 |
| 1073809141 | Amy Colleen Mcclintock | Family Medicine | 12255 De Paul Dr, Suite 600, Bridgeton, MO 63044-2510 | 2011-06-27 |
| 1528227113 | Eye Physicians of St Louis | Ophthalmology | 12255 De Paul Dr, Bridgeton, MO 63044-2510 | 2008-06-09 |
| 1790943728 | Depaul Optical | Technician/Technologist | 12255 De Paul Dr, Bridgeton, MO 63044-2510 | 2008-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225524911 | Premier Orthopaedic & Sports Medicine Assoc of Southern Nj LLC | Orthopaedic Surgery | 70 Manheim Ave Ste 1, Bridgeton, NJ 08302-2136 | 2018-07-05 |
| 1053616110 | Ssm Medical Group Inc. | Orthopaedic Surgery | 12349 De Paul Dr, Suite 100, Bridgeton, MO 63044 | 2011-01-21 |
| 1023034857 | Crystel D Knierim | Orthopaedic Surgery | 12266 Depaul Dr, 110, Bridgeton, MO 63044-2514 | 2006-07-14 |
| 1003875022 | Cohanzick Orthopedics Pa | Orthopaedic Surgery | 70 Manheim Avenue, Bridgeton, NJ 08302 | 2006-03-20 |
| 1174962922 | Ssm Depaul Medical Group | Orthopaedic Surgery | 12266 Depaul Drive, Suite 110, Bridgeton, MO 63044-2514 | 2013-06-14 |
| 1982702726 | Frank Tull | Orthopaedic Surgery | 12266 Depaul Drive, Suite 220, Bridgeton, MO 63044 | 2006-09-20 |
| 1508889577 | Ryan J Pomajzl | Orthopaedic Surgery | 12349 De Paul Dr Ste 100, Bridgeton, MO 63044-2512 | 2006-07-25 |
| 1255357091 | Randall D Roush | Orthopaedic Surgery | 12266 Depaul Dr, 110, Bridgeton, MO 63044-2514 | 2006-07-14 |
| 1154347995 | Terry J Weis | Orthopaedic Surgery | 12266 Depaul Dr, 110, Bridgeton, MO 63044-2514 | 2006-07-14 |
| 1447202197 | William C Schroer | Orthopaedic Surgery | 12349 De Paul Dr Ste 100, Bridgeton, MO 63044-2512 | 2006-05-17 |
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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.