| Ifm Community Medicine | |
|
9417 S Broadway Saint Louis MO 63125-2009 | |
| (314) 833-4030 | |
| (314) 833-4031 |
| Full Name | Ifm Community Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 9417 S Broadway, Saint Louis, Missouri |
| Authorized Official Name and Position | David C Campbell (CEO) |
| Authorized Official Contact | 3148334030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ifm Community Medicine 5501 Delmar Blvd Ste B560 Saint Louis MO 63112-3084 Ph: (314) 833-4030 | Ifm Community Medicine 9417 S Broadway Saint Louis MO 63125-2009 Ph: (314) 833-4030 |
| NPI Number | 1972567923 |
|---|---|
| Provider Enumeration Date | 04/14/2006 |
| Last Update Date | 12/11/2023 |
| Medicare PECOS PAC ID | 6608833587 |
|---|---|
| Medicare Enrollment ID | O20041213000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972567923 | NPI | - | NPPES |
| 506012806 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R1H15 (Missouri) | Primary |
| Provider Name | Mary V Hastings |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932365665 PECOS PAC ID: 2567528300 Enrollment ID: I20090304000099 |
| Provider Name | Samantha Lw Marquard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881836849 PECOS PAC ID: 5092865618 Enrollment ID: I20090602000473 |
| Provider Name | David C Campbell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801872254 PECOS PAC ID: 7618042425 Enrollment ID: I20100816000920 |
| Provider Name | Denise L Buck |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083760599 PECOS PAC ID: 2365610425 Enrollment ID: I20110718000269 |
| Provider Name | Lynelle Lois Hinden |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1255464939 PECOS PAC ID: 6709051774 Enrollment ID: I20111203000067 |
| Provider Name | Brook C Raye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710252176 PECOS PAC ID: 3870756992 Enrollment ID: I20120529000344 |
| Provider Name | Stacy L Lobello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902211063 PECOS PAC ID: 9234357914 Enrollment ID: I20140821000080 |
| Provider Name | Kimberly Garavaglia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538698733 PECOS PAC ID: 0648541532 Enrollment ID: I20170811000173 |
| Provider Name | Mechelle Lyles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609303411 PECOS PAC ID: 7315200847 Enrollment ID: I20180417000113 |
| Provider Name | Heather Noelle Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164799540 PECOS PAC ID: 9537405261 Enrollment ID: I20190116002629 |
| Provider Name | Lynelle Lois Hinden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255464939 PECOS PAC ID: 6709051774 Enrollment ID: I20190516000146 |
| Provider Name | Teresa Dumaine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356500300 PECOS PAC ID: 3779913900 Enrollment ID: I20200430001327 |
| Provider Name | Rosemary Kathleen Werner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013584952 PECOS PAC ID: 7517368871 Enrollment ID: I20210624002263 |
| Provider Name | Rachel Navarrette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174199319 PECOS PAC ID: 2365843570 Enrollment ID: I20210625000624 |
| Provider Name | Elizabeth Mary Dreyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952098758 PECOS PAC ID: 0244685246 Enrollment ID: I20231011002361 |
| Provider Name | Lauren Elizabeth Woll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265210066 PECOS PAC ID: 0446605901 Enrollment ID: I20231018003051 |
| Provider Name | Dena Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417648825 PECOS PAC ID: 7618334830 Enrollment ID: I20240208000927 |
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