| Mid-town Medical Practice, Llc | |
|
9 Sackston Woods Ln Creve Coeur MO 63141-8228 | |
| (314) 651-6132 | |
| Not Available |
| Full Name | Mid-town Medical Practice, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9 Sackston Woods Ln, Creve Coeur, Missouri |
| Authorized Official Name and Position | Iqbal Amin (PRESIDENT) |
| Authorized Official Contact | 3146516132 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-town Medical Practice, Llc 424 W 4th St Waterloo IL 62298-1378 Ph: (877) 748-7030 | Mid-town Medical Practice, Llc 9 Sackston Woods Ln Creve Coeur MO 63141-8228 Ph: (314) 651-6132 |
| NPI Number | 1023467008 |
|---|---|
| Provider Enumeration Date | 06/09/2016 |
| Last Update Date | 06/09/2016 |
| Medicare PECOS PAC ID | 5092007625 |
|---|---|
| Medicare Enrollment ID | O20160630000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023467008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Iqbal I Amin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184619835 PECOS PAC ID: 1658367974 Enrollment ID: I20040422000676 |
| Provider Name | Misrak Gebissa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184175085 PECOS PAC ID: 5991084808 Enrollment ID: I20161117000792 |
| Provider Name | La Tanya Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104121102 PECOS PAC ID: 2163743071 Enrollment ID: I20190816002633 |
| Provider Name | Jacinda Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447817952 PECOS PAC ID: 3779804067 Enrollment ID: I20191016002234 |
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4ever-young Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11716 Studt Ave, Creve Coeur, MO 63141 Phone: 314-330-8117 | |
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