| Mercy Clinic Illinois, Llc | |
|
1019 Valmeyer Rd Columbia IL 62236-4123 | |
| (314) 543-5244 | |
| (314) 543-5248 |
| Full Name | Mercy Clinic Illinois, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1019 Valmeyer Rd, Columbia, Illinois |
| Authorized Official Name and Position | Cheryl L Matejka (CFO) |
| Authorized Official Contact | 3142511958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic Illinois, Llc 1019 Valmeyer Rd Columbia IL 62236-4123 Ph: (314) 543-5244 | Mercy Clinic Illinois, Llc 1019 Valmeyer Rd Columbia IL 62236-4123 Ph: (314) 543-5244 |
| NPI Number | 1164089124 |
|---|---|
| Provider Enumeration Date | 05/24/2019 |
| Last Update Date | 05/24/2019 |
| Medicare PECOS PAC ID | 5193150621 |
|---|---|
| Medicare Enrollment ID | O20200110001085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164089124 | NPI | - | NPPES |
| Provider Name | Nancy Birner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043214778 PECOS PAC ID: 0840196192 Enrollment ID: I20031209000388 |
| Provider Name | Tina Louise Valentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356337224 PECOS PAC ID: 6608856935 Enrollment ID: I20040726000614 |
| Provider Name | Donna M Wagstaff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326030586 PECOS PAC ID: 3274441613 Enrollment ID: I20050922000889 |
| Provider Name | Carrie Daigle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477758571 PECOS PAC ID: 8022205871 Enrollment ID: I20101207000239 |
| Provider Name | Stephanie Simms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710492202 PECOS PAC ID: 4789930207 Enrollment ID: I20200131001098 |
| Provider Name | Jessica Dickman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669940656 PECOS PAC ID: 9537591730 Enrollment ID: I20211208000512 |
| Provider Name | Krista Covert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447848213 PECOS PAC ID: 9234542200 Enrollment ID: I20220107001088 |
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