JUSTIN BOLIN (NPI# 1225527633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225527633 |
| Entity Type | Individual |
| Full Name | JUSTIN BOLIN |
| Practice Address |
615 S New Ballas Rd Saint Louis MO 63141-8221 |
| Practice Telephone | 3142517921 |
| Practice Fax Number | 3142514815 |
| Mailing Telephone | 3142517921 |
| Mailing Fax Number | 3142514815 |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2018-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WD0400X |
Registered Nurse Specialization: Diabetes Educator |
2015024051 | MO | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MISSOURI STATE BOARD OF NURSING | 2015024051 | 01 |
| NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS | 21800005 | 01 |
| Street Address |
615 S NEW BALLAS RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780689182 | Robert W Allen | Anesthesiology | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2005-06-14 |
| 1033722061 | Ashley Maull | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-08-28 |
| 1508476367 | Ryan Nathan | Student in an Organized Health Care Education/Training Program | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-08-06 |
| 1992315857 | Corey Weicht | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-08-05 |
| 1063021905 | Alexandria Colleen Grodie | Nurse Practitioner | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-07-27 |
| 1396353892 | Fahad Bin Tahir | Internal Medicine | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-07-21 |
| 1588281307 | Alexander Cai | Dentist | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-06-26 |
| 1083231070 | Lauren Gonzalez | Anesthesiologist Assistant | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-06-25 |
| 1780200253 | Matthew Davis | Internal Medicine | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-06-22 |
| 1902422421 | Megan Reidy Landis | Family Medicine | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2020-06-20 |
| 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 | 163WD0400X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Diabetes Educator |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295351393 | Jacqueline S Futrell | Registered Nurse | 3660 Vista Ave Ste 204, Saint Louis, MO 63110-2540 | 2020-06-24 |
| 1154800241 | Schnuck Markets Inc | Registered Nurse | 11550 Page Service Dr Ste 101a, Saint Louis, MO 63146-3531 | 2018-08-09 |
| 1811925902 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 12756 Olive Blvd, Saint Louis, MO 63141-6211 | 2006-06-29 |
| 1902834096 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 5434 Southfield Ctr, Saint Louis, MO 63123-5907 | 2006-06-29 |
| 1447288535 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 60 Hampton Village Plz, Saint Louis, MO 63109-2127 | 2006-06-29 |
| 1023045465 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 10275 Clayton Rd, Saint Louis, MO 63124-1115 | 2006-06-28 |
| 1891721148 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 9540 Watson Rd, Saint Louis, MO 63126-1515 | 2006-06-25 |
| 1831125350 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 3431 Union Blvd, Saint Louis, MO 63115-1142 | 2006-06-25 |
| 1629004973 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 10070 Gravois Rd, Saint Louis, MO 63123-4024 | 2006-06-25 |
| 1083640338 | Missouri Cvs Pharmacy, L.L.C. | Registered Nurse | 3430 S Grand Blvd, Saint Louis, MO 63118-1004 | 2006-06-25 |
| Find all providers in SAINT LOUIS | ||||
| 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.