ICONIC SERVICES INC (NPI# 1750872354) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750872354 |
| Entity Type | Organization |
| Organization Name | ICONIC SERVICES INC |
| Practice Address |
4625 Lindell Blvd Ste 200 Saint Louis MO 63108-3729 |
| Practice Telephone | 3144378932 |
| Practice Fax Number | 8887492228 |
| Mailing Telephone | 3144378932 |
| Mailing Fax Number | 8887492228 |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-05-21 |
| Authorized Official Name | CHRISTINE B CORDERO (MANAGER) |
| Authorized Official Telephone | 3144378932 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
4625 LINDELL BLVD STE 200 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63108-3729 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215427349 | Heart To Heart Consolidated Home Care Service LLC | Home Health | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108 | 2018-05-15 |
| 1861035115 | Empowered Care, LLC | Nurse Practitioner | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108-3725 | 2019-10-18 |
| 1487295085 | Sierra Courtney | Home Health | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108-3725 | 2019-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851474 | Nigel Austen Thomas Cook | Social Worker | 4050 West Pine Blvd. Apt. 4118, St. Louis, MO 63108 | 2020-08-12 |
| 1467070011 | C2n Diagnostics, LLC | Clinical Medical Laboratory | 20 South Sarah Street, Saint Louis, MO 63108 | 2020-07-10 |
| 1609414358 | Kaylee Breitenbucher | Occupational Therapist | 4444 Forest Park Avenue, Msc 8505-94-01, St. Louis, MO 63108 | 2019-12-12 |
| 1114419546 | Activangels Home Health | Home Health | 4625 Lindell Blvd Ste 304, Saint Louis, MO 63108 | 2018-06-01 |
| 1447755905 | Erin Virginia Adams | Student in an Organized Health Care Education/Training Program | 4355 Maryland Ave Apt 116, Saint Louis, MO 63108 | 2018-03-27 |
| 1033621172 | Roots Healthcare and Homes | In Home Supportive Care | 4300 Enright Ave, St. Louis, MO 63108 | 2017-10-30 |
| 1336661719 | House of Destiny Adult Day Care LLC | Clinic/Center | 4507 Olive Street, St Louis, MO 63108 | 2017-07-07 |
| 1003338492 | Khin Min Thu | Social Worker | 4236 Lindell Blvd., Suite 200, St Louis, MO 63108 | 2017-07-07 |
| 1679093967 | Together We Can Home Healthcare Services LLC | Home Health | 4144 Lindell Blvd Suite 221, Saint Louis, MO 63108 | 2017-06-27 |
| 1720515729 | Rachel Hartman | Pharmacist | 115a N Euclid, St Louis, MO 63108 | 2017-05-22 |
| Find all providers in zip 63108 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871115857 | Ben Heimos | Family Medicine | 1 S Compton Ave, Saint Louis, MO 63103-2001 | 2020-05-12 |
| 1063568640 | Christian Verry | Family Medicine | 12680 Olive Blvd Ste 300, Saint Louis, MO 63141-6322 | 2007-01-26 |
| 1548867963 | Elizabeth Savika Liotta | Family Medicine | 916 Olive St, Saint Louis, MO 63101-1400 | 2020-10-08 |
| 1780948018 | St.. Louis University | Family Medicine | 1755 S Grand Blvd, Saint Louis, MO 63104-1540 | 2012-07-02 |
| 1619238235 | St. Anthony's Physician Organization | Family Medicine | 2900 Lemay Ferry Rd, Suite 104, Saint Louis, MO 63125-3900 | 2012-05-30 |
| 1306120183 | St Louis University | Family Medicine | 1755 S Grand Blvd, Saint Louis, MO 63104-1540 | 2011-09-28 |
| 1376778076 | Ha Minh Hoang | Family Medicine | 3635 Vista Ave, 7th Floor Desloge Towers, Saint Louis, MO 63110-2539 | 2009-05-26 |
| 1497958508 | William A. Mitchell IIi | Family Medicine | 1755 S Grand Blvd, Anheuser Busch Institute - Dept. of Orthopedics, Saint Louis, MO 63104-1540 | 2007-06-06 |
| 1295839702 | Kirkwood Diagnostic & Orthopedic Associates, LLC. | Family Medicine | 333 S Kirkwood Rd, Suite 203, Saint Louis, MO 63122-6161 | 2006-09-13 |
| 1578672341 | Steven Stahle | Family Medicine | 333 S Kirkwood Rd, Suite 103, Saint Louis, MO 63122-6161 | 2006-08-29 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63108 |
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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.