| Long Term Care Of North County Llc | |
|
4401 Parker Rd Black Jack MO 63033-4266 | |
| (314) 312-0720 | |
| Not Available |
| Full Name | Long Term Care Of North County Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4401 Parker Rd, Black Jack, Missouri |
| Authorized Official Name and Position | Mary Colette Schmidt (OWNER) |
| Authorized Official Contact | 3149224048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Term Care Of North County Llc Po Box 611 Florissant MO 63032-0611 Ph: (314) 312-0720 | Long Term Care Of North County Llc 4401 Parker Rd Black Jack MO 63033-4266 Ph: (314) 312-0720 |
| NPI Number | 1962915074 |
|---|---|
| Provider Enumeration Date | 11/10/2017 |
| Last Update Date | 12/22/2023 |
| Medicare PECOS PAC ID | 9032476171 |
|---|---|
| Medicare Enrollment ID | O20171128003166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962915074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary C Schmidt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174504682 PECOS PAC ID: 7719069103 Enrollment ID: I20080123000918 |
Chestnut Health Of Missouri Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13700 Old Halls Ferry Rd, Black Jack, MO 63033 Phone: 314-355-0760 Fax: 703-649-6188 |