| Success Health System, Llc | |
|
3600 Interstate 70 Dr Se Ste C Columbia MO 65201-6583 | |
| (888) 410-5230 | |
| Not Available |
| Full Name | Success Health System, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3600 Interstate 70 Dr Se Ste C, Columbia, Missouri |
| Authorized Official Name and Position | Moses Tabe Ambilichu (MD) |
| Authorized Official Contact | 9729740109 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Success Health System, Llc Po Box 716 Columbia MO 65205-0716 Ph: (972) 974-0109 | Success Health System, Llc 3600 Interstate 70 Dr Se Ste C Columbia MO 65201-6583 Ph: (888) 410-5230 |
| NPI Number | 1508310293 |
|---|---|
| Provider Enumeration Date | 08/10/2016 |
| Last Update Date | 07/31/2024 |
| Certification Date | 07/31/2024 |
| Medicare PECOS PAC ID | 2961787809 |
|---|---|
| Medicare Enrollment ID | O20170316000937 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508310293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2011019835 (Missouri) | Primary |
| Provider Name | Mary Bauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427006337 PECOS PAC ID: 5799738357 Enrollment ID: I20050224000037 |
| Provider Name | Moses Tabe Ambilichu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073774238 PECOS PAC ID: 8224205307 Enrollment ID: I20120112000211 |
| Provider Name | Tanya D Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386954022 PECOS PAC ID: 3779724794 Enrollment ID: I20130802000049 |
| Provider Name | Karanita Berniece Boling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477721306 PECOS PAC ID: 3971742149 Enrollment ID: I20160818002227 |
| Provider Name | Michelle Hoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801336243 PECOS PAC ID: 4486929759 Enrollment ID: I20171012001685 |
| Provider Name | Jana Ethel Reid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033619077 PECOS PAC ID: 7719248434 Enrollment ID: I20180220003130 |
| Provider Name | Marijen Sabas Aga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245575547 PECOS PAC ID: 9537447669 Enrollment ID: I20181120000638 |
| Provider Name | Derick Farmer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851874564 PECOS PAC ID: 7113359704 Enrollment ID: I20191120001732 |
| Provider Name | Kyria Anastasia Buchanan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629654298 PECOS PAC ID: 8628486552 Enrollment ID: I20210414001533 |
| Provider Name | Elizebeth Brake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952993354 PECOS PAC ID: 8224430426 Enrollment ID: I20210712000251 |
| Provider Name | Modupeola Falubi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689290017 PECOS PAC ID: 8729481833 Enrollment ID: I20210727003983 |
| Provider Name | Shakera Snelling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619464484 PECOS PAC ID: 4284999814 Enrollment ID: I20220902000613 |
| Provider Name | Sidoine Michele Magakou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134841117 PECOS PAC ID: 6002284767 Enrollment ID: I20230130000801 |
| Provider Name | Michelle Tholen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184322695 PECOS PAC ID: 3274906300 Enrollment ID: I20230310000302 |
| Provider Name | Tucker Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326746736 PECOS PAC ID: 3476928391 Enrollment ID: I20230406002259 |
| Provider Name | Nancy Dirks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689440083 PECOS PAC ID: 7618312455 Enrollment ID: I20240301003426 |
| Provider Name | Keara Cobbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083462451 PECOS PAC ID: 8729526249 Enrollment ID: I20240815001698 |
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