| Illumination Health, Llc | |
|
2355 Dougherty Ferry Rd Ste 410 Saint Louis MO 63122-3325 | |
| (314) 835-4873 | |
| (314) 336-6475 |
| Full Name | Illumination Health, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2355 Dougherty Ferry Rd Ste 410, Saint Louis, Missouri |
| Authorized Official Name and Position | James Snider (V.P. PHYSICIAN NETWORK) |
| Authorized Official Contact | 6366857804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illumination Health, Llc 121 Saint Lukes Center Dr Chesterfield MO 63017-3518 Ph: (636) 685-7804 | Illumination Health, Llc 2355 Dougherty Ferry Rd Ste 410 Saint Louis MO 63122-3325 Ph: (314) 835-4873 |
| NPI Number | 1992378384 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 02/04/2022 |
| Medicare PECOS PAC ID | 9032517099 |
|---|---|
| Medicare Enrollment ID | O20211006001811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992378384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 2083B0002X | Preventive Medicine - Obesity Medicine | (* (Not Available)) | Secondary |
| Provider Name | Sara I Hawatmeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710368584 PECOS PAC ID: 5092017848 Enrollment ID: I20190606001908 |
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