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10435 Clayton Rd Ste 110 Frontenac MO 63131-2930 | |
| (314) 312-2862 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Pain Medicine |
| Location | 10435 Clayton Rd Ste 110, Frontenac, Missouri |
| Authorized Official Name and Position | Kunj Govind Patel (DIRECTOR) |
| Authorized Official Contact | 3142827246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3909 Castellina Way Manteca CA 95337-8454 Ph: (314) 282-7246 | 10435 Clayton Rd Ste 110 Frontenac MO 63131-2930 Ph: (314) 312-2862 |
| NPI Number | 1871132720 |
|---|---|
| Provider Enumeration Date | 12/24/2019 |
| Last Update Date | 01/10/2022 |
| Medicare PECOS PAC ID | 9133555360 |
|---|---|
| Medicare Enrollment ID | O20200207000497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871132720 | NPI | - | NPPES |
| Provider Name | Kunj G Patel |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1699185249 PECOS PAC ID: 7113220864 Enrollment ID: I20200207000600 |
| Provider Name | Tisa Suzanne Ayers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134718893 PECOS PAC ID: 1456740422 Enrollment ID: I20211112000200 |
Nutriformance Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10407 Clayton Rd, Frontenac, MO 63131 Phone: 314-432-6103 Fax: 314-692-0448 |