CARESTL HEALTH #1 (NPI# 1972653202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972653202 |
| Entity Type | Organization |
| Organization Name | CARESTL HEALTH #1 |
| Other Organization Name | MYRTLE HILLIARD DAVIS COMPREHENSIVE |
| Practice Address |
5471 Dr Martin Luther King Dr Saint Louis MO 63112-4265 |
| Practice Telephone | 3143675820 |
| Practice Fax Number | 3144543979 |
| Mailing Telephone | 3143675820 |
| Mailing Fax Number | 3144543979 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-09-14 |
| Authorized Official Name | MRS. ANGELA RENEE CLABON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 3143675820 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
Suppliers | ||
| N | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
002938 | MO | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 600622914 | 05 | |
| PK | 2050332 | 01 |
| Other Name | Type Code |
|---|---|
| MYRTLE HILLIARD DAVIS COMPREHENSIVE | Doing Business As Name - Organization |
| Street Address |
5471 DR MARTIN LUTHER KING DR |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63112-4265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043825391 | Tiffany Shonta Klopner | Licensed Practical Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-09-14 |
| 1396359022 | Pamela Yvonne Wallace | Registered Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-09-01 |
| 1548874290 | Ashley D Whitley | Licensed Practical Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-09-01 |
| 1184235616 | Kendra Nailah Hughes | Licensed Practical Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-08-10 |
| 1780202135 | Amy Marie Heidotten | Registered Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-07-13 |
| 1376161729 | Monica Jeanne Witherspoon | Registered Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-07-13 |
| 1629691233 | Lavada Dolores James | Dental Hygienist | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-05-19 |
| 1851910277 | Raven Clay | Nurse's Aide | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-04-15 |
| 1093342800 | Brittany Xia Wright | Licensed Practical Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-03-24 |
| 1124652714 | Jaemi Madlambayan Tiongson | Registered Nurse | 5471 Dr Martin Luther King Dr, Saint Louis, MO 63112-4265 | 2020-02-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851932990 | Bobbie J. Harrington | Technician | 5626 Julian Avenue, St. Louis, MO 63112 | 2019-09-30 |
| 1861901480 | Christina Cummings | Counselor | 5387 Pershing Ave., Apt. A, St. Louis, MO 63112 | 2017-09-26 |
| 1326457177 | Clare Marie Salley | Speech-Language Pathologist | 5673 Waterman Blvd, Unit 31, St Louis, MO 63112 | 2014-08-06 |
| 1386999324 | Family Love Adult Health Care Center, LLC | Clinic/Center | 286 Debaliviere Avenue, St. Louis, MO 63112 | 2012-07-16 |
| 1003133893 | William Richard Humphrey II | Chiropractor | 5615 Pershing, Suite 22, St. Louis, MO 63112 | 2010-05-03 |
| 1558688408 | Courtney Lynne Luster | Counselor | 5647 Delmar Blvd Ste 226, Saint Louis, MO 63112 | 2010-04-30 |
| 1134446602 | Donald Trevor Cross | Psychologist | #7 Beverly Place, St. Louis, MO 63112 | 2010-04-23 |
| 1649507328 | Vikram Choudhary | Prosthetist | 6126 Washington Blvd, # 201, St. Louis, MO 63112 | 2009-11-17 |
| 1992930325 | Kelly Brook Hogan | Social Worker | 5355 Delmar, Saint Louis, MO 63112 | 2009-05-29 |
| 1942449194 | Annie Malone Children and Family Service Center | Respite Care | 5355 Page Avenue, St. Louis, MO 63112 | 2009-02-11 |
| Find all providers in zip 63112 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912483496 | Anna Rivkin | Pharmacy | 915 N Grand Blvd, Saint Louis, MO 63106-1621 | 2018-07-17 |
| 1578608808 | Betty Jean Kerr People's Health Centers | Pharmacy | 5701 Delmar Blvd, Saint Louis, MO 63112-2617 | 2007-02-21 |
| 1609969880 | Ssm Cardinal Glennon Childrens Hospital | Pharmacy | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2006-10-02 |
| 1134134745 | Affinia Healthcare | Pharmacy | 2220 Lemp Ave, Saint Louis, MO 63104-2700 | 2006-07-30 |
| 1093731945 | Affinia Healthcare | Pharmacy | 1717 Biddle St, Saint Louis, MO 63106-3454 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639738438 | Van Amburg & Busiek Md's, LLC | Pharmacy | 232 S Woodsmill Road, Suite 330 East, Chesterfield, MO 63017 | 2019-06-06 |
| 1649612219 | Metro Treatment of Missouri, Lp | Pharmacy | 3935 Sherman Ave, Saint Joseph, MO 64506-3649 | 2013-07-24 |
| 1437389723 | Walgreen Co | Pharmacy | 505 S Commercial St, Harrisonville, MO 64701-1651 | 2009-07-21 |
| 1932379369 | Dowel LLC | Pharmacy | 810 W 35th St, Ste 101, Higginsville, MO 64037-1872 | 2008-02-29 |
| 1760673248 | Walgreen Co | Pharmacy | 100 Jason Dr, Troy, MO 63379-1944 | 2007-08-08 |
| 1639213267 | Central Pharmacy | Pharmacy | 1611 Lurlyn Dr, Poplar Bluff, MO 63901-2763 | 2007-02-16 |
| 1154427516 | Kreisler Clnic Pharmacy | Pharmacy | 1602 N. Second St., Clinton, MO 64735 | 2006-09-15 |
| 1720566805 | Advocates for A Healthy Community, Inc. | Pharmacy | 860 Lynn St, Lebanon, MO 65536-3810 | 2018-08-01 |
| 1891236170 | Advocates for A Healthy Community, Inc. | Pharmacy | 860 Lynn St, Lebanon, MO 65536-3832 | 2017-03-20 |
| 1346696572 | Burrell, Inc. | Pharmacy | 3401 Berrywood Dr, Suite 102, Columbia, MO 65201-6515 | 2016-05-06 |
| Find all providers with the same taxonomy | ||||
| City | SAINT LOUIS |
| Zip Code | 63112 |
Please comment or provide details below to improve the information on CARESTL HEALTH #1.
| 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.