| Liaison Health Group, Llc | |
|
9628 Midland Blvd Overland MO 63114-3357 | |
| (314) 779-6022 | |
| Not Available |
| Full Name | Liaison Health Group, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9628 Midland Blvd, Overland, Missouri |
| Authorized Official Name and Position | Wogene Amsalu (NURSE PRACTITIONER) |
| Authorized Official Contact | 3147796022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liaison Health Group, Llc 9628 Midland Blvd Overland MO 63114-3357 Ph: (314) 779-6022 | Liaison Health Group, Llc 9628 Midland Blvd Overland MO 63114-3357 Ph: (314) 779-6022 |
| NPI Number | 1033874888 |
|---|---|
| Provider Enumeration Date | 11/06/2021 |
| Last Update Date | 01/13/2023 |
| Medicare PECOS PAC ID | 6901298298 |
|---|---|
| Medicare Enrollment ID | O20220118002422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033874888 | NPI | - | NPPES |
| 2018001284 | Other | MO | BOARD OF NURSING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Wogene Amsalu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184091431 PECOS PAC ID: 7113331794 Enrollment ID: I20210121001849 |
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