| Evolution Md, Llc | |
|
522 N New Ballas Rd Ste 317 Creve Coeur MO 63141-6840 | |
| (636) 534-0200 | |
| (636) 534-0201 |
| Full Name | Evolution Md, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 522 N New Ballas Rd Ste 317, Creve Coeur, Missouri |
| Authorized Official Name and Position | Jose Marino Parra (OWNER) |
| Authorized Official Contact | 6365340200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Md, Llc Po Box 37002 Saint Louis MO 63141-1502 Ph: () - | Evolution Md, Llc 522 N New Ballas Rd Ste 317 Creve Coeur MO 63141-6840 Ph: (636) 534-0200 |
| NPI Number | 1699425314 |
|---|---|
| Provider Enumeration Date | 03/25/2022 |
| Last Update Date | 04/11/2022 |
| Medicare PECOS PAC ID | 6800282104 |
|---|---|
| Medicare Enrollment ID | O20220414001066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699425314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jose M Parra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821283193 PECOS PAC ID: 9931267804 Enrollment ID: I20100206000211 |
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