| Bellefontaine Habilitation Center | |
|
10695 Bellefontaine Rd Saint Louis MO 63137-2315 | |
| (314) 340-6000 | |
| (314) 340-6199 |
| Full Name | Bellefontaine Habilitation Center |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 10695 Bellefontaine Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Molly Jane Boeckmann (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 5737514055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bellefontaine Habilitation Center 1706 E Elm St Jefferson City MO 65101-4130 Ph: (573) 751-3398 | Bellefontaine Habilitation Center 10695 Bellefontaine Rd Saint Louis MO 63137-2315 Ph: (314) 340-6000 |
| NPI Number | 1710931167 |
|---|---|
| Provider Enumeration Date | 05/20/2006 |
| Last Update Date | 10/27/2020 |
| Medicare PECOS PAC ID | 1456254226 |
|---|---|
| Medicare Enrollment ID | O20041208000473 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710931167 | NPI | - | NPPES |
| 501500102 | Medicaid | MO | |
| CG4952 | Other | MO | MEDICARE RAILROAD |
| Provider Name | Sridevi Gavirneni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366545543 PECOS PAC ID: 8628026697 Enrollment ID: I20050106000156 |
| Provider Name | Amged A Eltahir |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669499372 PECOS PAC ID: 2769584333 Enrollment ID: I20070228000317 |
| Provider Name | Akinrinola Fatoki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346354693 PECOS PAC ID: 2062309230 Enrollment ID: I20070731000158 |
| Provider Name | Seema Najam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396817490 PECOS PAC ID: 1850476995 Enrollment ID: I20100730000013 |
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