| Mercy Clinic Infectious Disease Llc | |
|
621 S New Ballas Rd Suite 140a Saint Louis MO 63141-8232 | |
| (314) 251-8897 | |
| (314) 251-8898 |
| Full Name | Mercy Clinic Infectious Disease Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 621 S New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | John W. Hubert (PRESIDENT) |
| Authorized Official Contact | 3142511560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic Infectious Disease Llc 621 S New Ballas Rd Suite 140a Saint Louis MO 63141-8232 Ph: (314) 251-8897 | Mercy Clinic Infectious Disease Llc 621 S New Ballas Rd Suite 140a Saint Louis MO 63141-8232 Ph: (314) 251-8897 |
| NPI Number | 1902141641 |
|---|---|
| Provider Enumeration Date | 12/06/2012 |
| Last Update Date | 12/06/2012 |
| Medicare PECOS PAC ID | 6103058862 |
|---|---|
| Medicare Enrollment ID | O20140410002004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902141641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Jad A Khoury |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144250028 PECOS PAC ID: 9537182092 Enrollment ID: I20060110001152 |
| Provider Name | Jin Wang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477790459 PECOS PAC ID: 7618022625 Enrollment ID: I20090827000038 |
| Provider Name | Jason John Gass |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1700224201 PECOS PAC ID: 7012151020 Enrollment ID: I20181006000244 |
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