WUCA-FENTON PEDIATRICS, LLC (NPI# 1760953095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760953095 |
| Entity Type | Organization |
| Organization Name | WUCA-FENTON PEDIATRICS, LLC |
| Other Organization Name | WUCA - FENTON PEDIATRICS, LLC |
| Practice Address |
714 Gravois Rd Ste 200 Fenton MO 63026-7723 |
| Mailing Address |
4240 Duncan Ave Ste 301 Saint Louis MO 63110-1123 |
| Practice Telephone | 6363495437 |
| Practice Fax Number | 6363496663 |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2019-10-02 |
| Authorized Official Name | CATHY EGHIGIAN (DIRECTOR, CREDENTIALING OPERATIONS) |
| Authorized Official Telephone | 3142730770 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| WUCA - Fenton Pediatrics, LLC | Other Name - Individual/Organization |
| Street Address |
714 GRAVOIS RD STE 200 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-7723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801246053 | Daisy Zhou | Pediatrics | 714 Gravois Rd Ste 200, Fenton, MO 63026-7723 | 2016-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087854 | Advance Counseling Services, LLC | Clinic/Center | 110 Trealout Dr Ste 103, Fenton, MI 48430-3211 | 2020-09-14 |
| 1437569647 | Therapy Support Center LLC | Clinic/Center | 113 North River Street, Fenton, MI 48430 | 2014-04-28 |
| 1750664991 | Fenton Vision Sensory and Learning Center Pllc | Clinic/Center | 1535 N Leroy St, Suite D, Fenton, MI 48430-2791 | 2011-09-23 |
| 1770789984 | Ssm Medical Group | Clinic/Center | 1747 Smizer Station Rd, Suite 6, Fenton, MO 63026-2784 | 2007-06-25 |
| 1700966207 | Ssm Medical Group, Inc. | Clinic/Center | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2395 | 2006-10-17 |
| 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 | ||||
Please comment or provide details below to improve the information on WUCA-FENTON PEDIATRICS, LLC.
| 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.