LAURA WAGNER, INC (NPI# 1487801635) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487801635 |
| Entity Type | Organization |
| Organization Name | LAURA WAGNER, INC |
| Practice Address |
6 Jungermann Cir Suite 211 Saint Peters MO 63376-1621 |
| Mailing Address |
Po Box 790379 Saint Louis MO 63179-0379 |
| Practice Telephone | 6369267938 |
| Practice Fax Number | 6369262286 |
| Mailing Telephone | 6369267938 |
| Mailing Fax Number | 6369262286 |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |
| Authorized Official Name | LAURA ELLA WAGNER (PRESIDENT) |
| Authorized Official Telephone | 6369268554 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | R8N01 | MO | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | GHP PROVIDER # | 39228V39228 | 01 |
| MO | MEDICARE PTAN # | 00004839 | 01 |
| MO | HEALTHLINK ID# | 211386 | 01 |
| MO | AETNA PROVIDER # | 4420124 | 01 |
| MO | TYPE 1 NPI | 1669445060 | 01 |
| MO | BCBSMO PROVIDER# | 18374 | 01 |
| Street Address |
6 JUNGERMANN CIR SUITE 211 |
| City | SAINT PETERS |
| State | MO |
| Zip Code | 63376-1621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194716688 | Mark S Wald | Internal Medicine | 6 Jungermann Cir, Suite 210, Saint Peters, MO 63376-1621 | 2005-11-02 |
| 1639423742 | Bjsph Physician Billing Services, LLC | Clinic/Center | 6 Jungermann Cir, Suite 205, Saint Peters, MO 63376-1621 | 2012-10-29 |
| 1699001958 | Tatyana Petrosova, M.d.p.c. | Internal Medicine | 6 Jungermann Cir, Suite 215, Saint Peters, MO 63376-1621 | 2009-10-21 |
| 1821245457 | Subbarao Polineni, M.d. PC | Orthopaedic Surgery | 6 Jungermann Cir, Ste 107, Saint Peters, MO 63376-1621 | 2008-08-26 |
| 1114193083 | Jennifer L Keen | Nurse Practitioner | 6 Jungermann Cir, Suite 209, Saint Peters, MO 63376-1621 | 2008-05-01 |
| 1255522819 | Respiratory Disease Consultants, LLC | Internal Medicine | 6 Jungermann Cir, Suite 121, Saint Peters, MO 63376-1621 | 2007-08-07 |
| 1396945168 | St. Charles Nephrology | Internal Medicine | 6 Jungermann Cir, Suite 215, Saint Peters, MO 63376-1621 | 2007-07-20 |
| 1629132519 | Josephine May Kelly | Psychologist | 6 Jungermann Cir, Suite 203, Saint Peters, MO 63376-1621 | 2006-12-22 |
| 1093878258 | Ron Javdan | Internal Medicine | 6 Jungermann Cir, Suite 203, Saint Peters, MO 63376-1621 | 2006-12-19 |
| 1578630638 | William F Sill | Family Medicine | 6 Jungermann Cir, 108, Saint Peters, MO 63376-1621 | 2006-11-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275047946 | Nicholas Christian Schultz | Dentist | 100 Piper Hill Dr Ste A, Saint Peters, MO 63376 | 2017-11-16 |
| 1982120093 | Carol Weber | Speech-Language Pathologist | 166 Boone Hills Dr., St Peters, MO 63376 | 2017-08-21 |
| 1619424744 | Forefront Dermatology, S.c. | Dermatology | 5700 Mexico Rd, Suite 14, Saint Peters, MO 63376 | 2016-09-07 |
| 1508310632 | Preferred Family Healthcare, Inc. | Counselor | 2120 Parkway Dr, Saint Peters, MO 63376 | 2016-08-05 |
| 1598130676 | Delta Center Personal Attendant Services | In Home Supportive Care | 3833 Mcclay, Suite 61, St. Peters, MO 63376 | 2015-12-01 |
| 1427420314 | Barbara Marlene Edelman | Counselor | 1286 Jungerman Rd. Suite G, St. Peters, MO 63376 | 2015-10-30 |
| 1255740247 | Claire Williams | Dentist | 340 Mid Rivers Mall Drive, Suite E, St. Peters, MO 63376 | 2014-08-05 |
| 1184042855 | Keith Wickenhauser | Internal Medicine | 201 Bjc Saint Peters Dr Ste 100, Saint Peters, MO 63376 | 2014-03-31 |
| 1821415233 | Abby Link | Physician Assistant | 107 Piper Parkway, #150, St. Peters, MO 63376 | 2014-03-24 |
| 1225452105 | Ashley Gagel | Physical Therapist | 7055 Mexico Rd Suite 1601, St. Peters, MO 63376 | 2014-02-12 |
| Find all providers in zip 63376 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134286107 | Stephanie Pauline Adams | Specialist | 1370 Triad Center Dr, Saint Peters, MO 63376-7350 | 2007-01-02 |
| 1003938887 | Executive Centre Surgical Services | Specialist | 145 Saint Peters Centre Blvd, Saint Peters, MO 63376-5103 | 2007-04-04 |
| 1598775058 | Pulmonary Disease Consultants, Inc. | Specialist | 201 First Executive Ave, Saint Peters, MO 63376-1697 | 2006-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497381990 | Styles 40 Salon | Specialist | 4550 Gravois Ave, Saint Louis, MO 63116-2426 | 2020-03-16 |
| 1013560721 | Against The Grainz | Specialist | 8523 Drury Ln, Saint Louis, MO 63147-1313 | 2019-07-22 |
| 1487211033 | Kia Lanay Lewis | Specialist | 9700 Portage Dr, Saint Louis, MO 63136-5312 | 2019-05-20 |
| 1659935815 | Nicole Pittman | Specialist | 3004 Chance Dr, Florissant, MO 63031-1436 | 2019-04-23 |
| 1376011007 | Lashonda S Wash | Specialist | 222 Bruce Ave, Saint Louis, MO 63135-2704 | 2018-11-12 |
| 1326516048 | Showna Walker | Specialist | 2242 Berwyn Dr, Saint Louis, MO 63136-5415 | 2018-11-12 |
| 1306326061 | Sleek Barber & Beauty Salon | Specialist | 13220 New Halls Ferry Rd, Florissant, MO 63033-3231 | 2018-08-21 |
| 1760973697 | Angela Haas | Specialist | 1361 Childress Ave, Saint Louis, MO 63139-3451 | 2018-05-26 |
| 1164913497 | Gina Marie Savage | Specialist | 2400 Troost Ave Ste 3400, Kansas City, MO 64108-2666 | 2018-05-22 |
| 1962907782 | Kelsey Conley | Specialist | 2839 Howard St, Saint Louis, MO 63106-2027 | 2018-03-25 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PETERS |
| Zip Code | 63376 |
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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.