| Premier Medical Physicians Llc | |
|
2325 Dougherty Ferry Rd Ste 104 Saint Louis MO 63122-3356 | |
| (314) 821-6889 | |
| (314) 821-1887 |
| Full Name | Premier Medical Physicians Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2325 Dougherty Ferry Rd Ste 104, Saint Louis, Missouri |
| Authorized Official Name and Position | James Snider (VP PHYSICIAN NETWORK) |
| Authorized Official Contact | 6366857804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical Physicians Llc 232 S Woods Mill Rd Chesterfield MO 63017-3406 Ph: (366) 857-8046 | Premier Medical Physicians Llc 2325 Dougherty Ferry Rd Ste 104 Saint Louis MO 63122-3356 Ph: (314) 821-6889 |
| NPI Number | 1417459207 |
|---|---|
| Provider Enumeration Date | 03/07/2018 |
| Last Update Date | 04/06/2021 |
| Medicare PECOS PAC ID | 6507129699 |
|---|---|
| Medicare Enrollment ID | O20180425000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417459207 | NPI | - | NPPES |
| Provider Name | Anahit Danielyan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629007711 PECOS PAC ID: 8325065196 Enrollment ID: I20051031000973 |
| Provider Name | Brenda L Buckley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134104466 PECOS PAC ID: 2365541208 Enrollment ID: I20070619000205 |
| Provider Name | David Kantor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801994926 PECOS PAC ID: 3375620909 Enrollment ID: I20080408000088 |
| Provider Name | Michele Neudecker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851381206 PECOS PAC ID: 6305973538 Enrollment ID: I20100420000943 |
| Provider Name | Vincent P Fortunato |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174508436 PECOS PAC ID: 9234254947 Enrollment ID: I20100918000139 |
| Provider Name | Annamarie Elizabeth Goldstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093235970 PECOS PAC ID: 0547539926 Enrollment ID: I20200722003335 |
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