| Shoal Creek Foot And Ankle Center Llc | |
|
1801 W 32nd St Ste 102, Joplin, MO 64804-1528 | |
| (417) 622-0648 | |
| (417) 622-0497 |
| Full Name | Shoal Creek Foot And Ankle Center Llc |
|---|---|
| Type | Facility |
| Speciality | Podiatrist - Foot & Ankle Surgery |
| Location | 1801 W 32nd St Ste 102, Joplin, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346722055 | NPI | - | NPPES |
| 300054533 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 2018010120 (Missouri) | Primary |
| Provider Name | Shelly Diane Sedberry |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1770978074 PECOS PAC ID: 8426379041 Enrollment ID: I20180523000729 |
| Provider Name | Jennifer L Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932757291 PECOS PAC ID: 7012247042 Enrollment ID: I20190918000530 |
| Provider Name | Caleb N Pace |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1124548086 PECOS PAC ID: 6305262205 Enrollment ID: I20200821000767 |
| Provider Name | Brittany Marie-noelle Ciaramello |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1104288141 PECOS PAC ID: 3577857176 Enrollment ID: I20201006001149 |
| Provider Name | Lucas Samuel Tebbe |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1417519257 PECOS PAC ID: 8527448570 Enrollment ID: I20220707003071 |
| Provider Name | Douglas Hendrex |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447486790 PECOS PAC ID: 1254587744 Enrollment ID: I20231127001415 |
| Mailing Address | Practice Location Address |
|---|---|
| Shoal Creek Foot And Ankle Center Llc Po Box 4427, Joplin, MO 64803-4427 Ph: (417) 622-0648 | Shoal Creek Foot And Ankle Center Llc 1801 W 32nd St Ste 102, Joplin, MO 64804-1528 Ph: (417) 622-0648 |
Dr. Matthew B Richins, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 2630 Cunningham Ave Ste 201, Joplin, MO 64804 Phone: 417-782-7500 Fax: 417-782-7524 | |
Jared A Stanton, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 100 Mercy Way, Suite 420, Joplin, MO 64804 Phone: 417-556-2278 Fax: 417-556-2277 | |
Dr. James T Hamilton, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 2531 B East 32nd Street, Joplin, MO 64804 Phone: 417-624-8408 Fax: 417-624-7828 | |
Haste Podiatry Clinics P C Podiatrist Medicare: Medicare Enrolled Practice Location: 1617 W 26th St Ste A, Joplin, MO 64804 Phone: 417-659-9395 Fax: 417-659-9695 | |
Valarie L Ikerd, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1501 E 20th St, Joplin, MO 64804 Phone: 417-659-9395 Fax: 417-659-9565 | |
Jeffrey L Haste, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1617 W 26th St Ste A, Joplin, MO 64804 Phone: 417-659-9395 Fax: 417-659-9695 |