| Ipc Pac Healthcare Services Of Missouri Inc | |
|
12101 Woodcrest Executive Dr Suite 210 Saint Louis MO 63141-5047 | |
| (314) 317-0600 | |
| Not Available |
| Full Name | Ipc Pac Healthcare Services Of Missouri Inc |
|---|---|
| Speciality | Hospitalist |
| Location | 12101 Woodcrest Executive Dr, Saint Louis, Missouri |
| Authorized Official Name and Position | Randal Dabbs (PRESIDENT) |
| Authorized Official Contact | 8656931000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ipc Pac Healthcare Services Of Missouri Inc 265 Brookview Centre Way Ste 400 Knoxville TN 37919-4052 Ph: (865) 693-1000 | Ipc Pac Healthcare Services Of Missouri Inc 12101 Woodcrest Executive Dr Suite 210 Saint Louis MO 63141-5047 Ph: (314) 317-0600 |
| NPI Number | 1326497587 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 07/29/2016 |
| Medicare PECOS PAC ID | 4587950589 |
|---|---|
| Medicare Enrollment ID | O20160830002898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326497587 | NPI | - | NPPES |
| Provider Name | Mary Ann Lillig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902899834 PECOS PAC ID: 9335107184 Enrollment ID: I20041227000198 |
| Provider Name | William F Sudholt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164486254 PECOS PAC ID: 1759305378 Enrollment ID: I20060124000100 |
| Provider Name | Jacqueline J Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194704312 PECOS PAC ID: 7012076821 Enrollment ID: I20081110000072 |
| Provider Name | Thomas Wayne Fulbright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548213119 PECOS PAC ID: 1557302080 Enrollment ID: I20090320000099 |
| Provider Name | Cierra Nicole Dillard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649592296 PECOS PAC ID: 7012049232 Enrollment ID: I20100722000882 |
| Provider Name | Alison Leigh Welch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265730899 PECOS PAC ID: 8224213053 Enrollment ID: I20110421000181 |
| Provider Name | Angela Pike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790065068 PECOS PAC ID: 9638340714 Enrollment ID: I20110921000452 |
| Provider Name | Martha L Lapietra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932194925 PECOS PAC ID: 2365548054 Enrollment ID: I20120105000859 |
| Provider Name | Julia C Bradbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700122306 PECOS PAC ID: 6406091115 Enrollment ID: I20130426000473 |
| Provider Name | Jennifer L Hargis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124438932 PECOS PAC ID: 7618191081 Enrollment ID: I20140605001372 |
| Provider Name | Trista Calhoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659787281 PECOS PAC ID: 5395060255 Enrollment ID: I20150303001020 |
| Provider Name | Ann Heatherly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598189615 PECOS PAC ID: 4082846373 Enrollment ID: I20160602000648 |
| Provider Name | Valerie Njuguna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811340508 PECOS PAC ID: 7416241872 Enrollment ID: I20160822001219 |
| Provider Name | Lucyanne Moraa Okwomi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508309329 PECOS PAC ID: 3971883240 Enrollment ID: I20161201001881 |
| Provider Name | James E Burrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659819688 PECOS PAC ID: 3072897230 Enrollment ID: I20170307001673 |
| Provider Name | Seema Sharma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467992057 PECOS PAC ID: 9335424530 Enrollment ID: I20170510002266 |
| Provider Name | Kelsy G Darby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740701804 PECOS PAC ID: 9739452509 Enrollment ID: I20170830003137 |
| Provider Name | Jeena Eapen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023018926 PECOS PAC ID: 2062483092 Enrollment ID: I20170906000708 |
| Provider Name | David B Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144490467 PECOS PAC ID: 8628155348 Enrollment ID: I20171215002036 |
| Provider Name | Lisa Carol Schweich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053739193 PECOS PAC ID: 2365667797 Enrollment ID: I20200316001091 |
| Provider Name | Sospeter O Otieno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609418763 PECOS PAC ID: 9436584406 Enrollment ID: I20200325002798 |
| Provider Name | Susan Julia Wurtenberger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720670508 PECOS PAC ID: 7416357066 Enrollment ID: I20210618000255 |
| Provider Name | Edith Kendi Muriuki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326718115 PECOS PAC ID: 7517365174 Enrollment ID: I20211012001922 |
| Provider Name | Linda Daniel-dim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962174896 PECOS PAC ID: 6406245612 Enrollment ID: I20211109003096 |
| Provider Name | Concilia Amaonye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154736445 PECOS PAC ID: 2769875319 Enrollment ID: I20220203001772 |
| Provider Name | Shenella Carlisle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235641267 PECOS PAC ID: 8921353400 Enrollment ID: I20220324002272 |
| Provider Name | Francis Umunna Okafor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093457111 PECOS PAC ID: 1456728427 Enrollment ID: I20230119000766 |
| Provider Name | Bincy Joji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396105656 PECOS PAC ID: 2961791488 Enrollment ID: I20230126001050 |
| Provider Name | Libby John |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598149932 PECOS PAC ID: 0345509345 Enrollment ID: I20230130001855 |
| Provider Name | Rachel B Smith-langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265834998 PECOS PAC ID: 5799007779 Enrollment ID: I20230201001614 |
| Provider Name | Deepa Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053725333 PECOS PAC ID: 4284856949 Enrollment ID: I20230208001953 |
| Provider Name | Fonshay Latrice Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588814263 PECOS PAC ID: 0840354833 Enrollment ID: I20230414000079 |
| Provider Name | Kaely Marie Mayden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518658418 PECOS PAC ID: 7214390145 Enrollment ID: I20230825000375 |
| Provider Name | Danience Moreland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518238971 PECOS PAC ID: 8921442823 Enrollment ID: I20240220000135 |
| Provider Name | Emily J Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124886106 PECOS PAC ID: 1153760707 Enrollment ID: I20240416002863 |
| Provider Name | Ashlee Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003334798 PECOS PAC ID: 2264787704 Enrollment ID: I20240501001926 |
| Provider Name | Melissa L Cadwalader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801630900 PECOS PAC ID: 2668918640 Enrollment ID: I20240726001219 |
| Provider Name | Patrice Wanetta Dumas Veraguth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992900492 PECOS PAC ID: 4981143369 Enrollment ID: I20240829001255 |
| Provider Name | James Horst |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235154089 PECOS PAC ID: 8426031337 Enrollment ID: I20240927000419 |
| Provider Name | Marissa Ludwig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972348480 PECOS PAC ID: 4880126978 Enrollment ID: I20241014004228 |
| Provider Name | Lori Stairs Bohnen Justice |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669851473 PECOS PAC ID: 9032558077 Enrollment ID: I20241213003363 |
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