| Altea Medical Missouri Llc | |
|
1441 Charic Dr Wildwood MO 63021-2001 | |
| (636) 394-2522 | |
| Not Available |
| Full Name | Altea Medical Missouri Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1441 Charic Dr, Wildwood, Missouri |
| Authorized Official Name and Position | Jodhvir Singh Sarai (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3474321603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altea Medical Missouri Llc 2219 Rimland Dr Ste 301 Bellingham WA 98226-8759 Ph: () - | Altea Medical Missouri Llc 1441 Charic Dr Wildwood MO 63021-2001 Ph: (636) 394-2522 |
| NPI Number | 1649032608 |
|---|---|
| Provider Enumeration Date | 01/25/2024 |
| Last Update Date | 11/19/2024 |
| Medicare PECOS PAC ID | 0143768762 |
|---|---|
| Medicare Enrollment ID | O20240814002635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649032608 | NPI | - | NPPES |
| Provider Name | Jawed H Siddiqui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699705293 PECOS PAC ID: 5799762415 Enrollment ID: I20040701000288 |
| Provider Name | Andrea E Ivy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649220104 PECOS PAC ID: 7618930090 Enrollment ID: I20041106000029 |
| Provider Name | Betsy L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538443072 PECOS PAC ID: 5991001976 Enrollment ID: I20160317001269 |
| Provider Name | Shelly Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881008498 PECOS PAC ID: 9436379237 Enrollment ID: I20160622002304 |
| Provider Name | Elizabeth Hudgins Maylack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154687077 PECOS PAC ID: 4082907191 Enrollment ID: I20180808003748 |
| Provider Name | Chimnoya N Nwagwu-youlo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881910487 PECOS PAC ID: 2769613611 Enrollment ID: I20200930001385 |
| Provider Name | Shanika Shanta Pruitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659818904 PECOS PAC ID: 5799177408 Enrollment ID: I20220108000173 |
| Provider Name | Sharonda A Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588324727 PECOS PAC ID: 2264824879 Enrollment ID: I20220111001691 |
| Provider Name | Tamica T Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891449013 PECOS PAC ID: 5890180426 Enrollment ID: I20220318000184 |
| Provider Name | Agnes Yahl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023089190 PECOS PAC ID: 4183651128 Enrollment ID: I20230710001117 |
| Provider Name | Jodhvir Sarai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972816718 PECOS PAC ID: 8628202124 Enrollment ID: I20240930002042 |
| Provider Name | Lacey C Sierra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154022275 PECOS PAC ID: 0648702852 Enrollment ID: I20241014000639 |
Illinois Rural Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17781 Hornbean Dr, Wildwood, MO 63005 Phone: 312-953-5636 | |
Idim Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1909 Larimer Trl, Wildwood, MO 63011 Phone: 636-273-5311 | |
Wildwood Internal Medicine, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16759 Main Street, Suite 203, Wildwood, MO 63040 Phone: 636-458-4800 Fax: 636-594-7500 |