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200 Corporate Lake Dr Columbia MO 65203-7172 | |
| (573) 814-1170 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 200 Corporate Lake Dr, Columbia, Missouri |
| Authorized Official Name and Position | Adam Wheeler (CEO) |
| Authorized Official Contact | 5736735770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
200 Corporate Lake Dr Columbia MO 65203-7172 Ph: (573) 814-1170 | 200 Corporate Lake Dr Columbia MO 65203-7172 Ph: (573) 814-1170 |
| NPI Number | 1740858562 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 01/04/2023 |
| Certification Date | 01/04/2023 |
| Medicare PECOS PAC ID | 6507232543 |
|---|---|
| Medicare Enrollment ID | O20221017002513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740858562 | NPI | - | NPPES |
| Provider Name | Adam D Wheeler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891803086 PECOS PAC ID: 5395802318 Enrollment ID: I20090318000646 |
| Provider Name | Sarah Lynne Calhoun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952404949 PECOS PAC ID: 5799831475 Enrollment ID: I20090922000335 |
| Provider Name | Bonni N Heithold |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265720106 PECOS PAC ID: 1052545860 Enrollment ID: I20140911001191 |
| Provider Name | Calla Anne Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134604192 PECOS PAC ID: 3274878475 Enrollment ID: I20181217001014 |
| Provider Name | Ashlee Kathleen Parkes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013542109 PECOS PAC ID: 0143659052 Enrollment ID: I20200327002497 |
| Provider Name | Michael James Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174271803 PECOS PAC ID: 2163819046 Enrollment ID: I20220422001603 |
| Provider Name | Trevor Perdue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861179129 PECOS PAC ID: 6901251321 Enrollment ID: I20231004003155 |
| Provider Name | Pavel Svintozelsky |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1144868019 PECOS PAC ID: 3173055100 Enrollment ID: I20241016001091 |
| Provider Name | Chase Vargo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043066483 PECOS PAC ID: 3072045780 Enrollment ID: I20241019000142 |
| Provider Name | Sarah Anne Brooks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871274654 PECOS PAC ID: 9739611393 Enrollment ID: I20241021002277 |
| Provider Name | Lauren Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629755871 PECOS PAC ID: 9335672765 Enrollment ID: I20241024000215 |
| Provider Name | Larissa Rose O'keefe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053191163 PECOS PAC ID: 4183157548 Enrollment ID: I20241024001595 |
| Provider Name | Andrea Nicole Petersen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669083382 PECOS PAC ID: 8921532318 Enrollment ID: I20241107001920 |
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