| Premier Pediatrics | |
|
5114 Mid America Plz Ste 2c Saint Louis MO 63129-0003 | |
| (314) 859-4000 | |
| (314) 273-4110 |
| Full Name | Premier Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 5114 Mid America Plz Ste 2c, Saint Louis, Missouri |
| Authorized Official Name and Position | Cathy Eghigian (DIRECTOR, CREDENTIALING OPERATIONS) |
| Authorized Official Contact | 3142730770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Pediatrics 150 Richardson Xing Arnold MO 63010-6023 Ph: (314) 859-4000 | Premier Pediatrics 5114 Mid America Plz Ste 2c Saint Louis MO 63129-0003 Ph: (314) 859-4000 |
| NPI Number | 1083195762 |
|---|---|
| Provider Enumeration Date | 08/22/2018 |
| Last Update Date | 11/06/2023 |
| Medicare PECOS PAC ID | 3678817921 |
|---|---|
| Medicare Enrollment ID | O20181128000250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083195762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Julia C Young |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023024163 PECOS PAC ID: 9335386945 Enrollment ID: I20130517000454 |
| Provider Name | Jennifer Foersterling |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851378475 PECOS PAC ID: 4385988633 Enrollment ID: I20181128000349 |
| Provider Name | George C Anderson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669497764 PECOS PAC ID: 7315281672 Enrollment ID: I20181128000624 |
| Provider Name | Sandeep Rohatgi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194791335 PECOS PAC ID: 8426054800 Enrollment ID: I20181226001170 |
| Provider Name | Linda Tackes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003848425 PECOS PAC ID: 2567427883 Enrollment ID: I20181226001265 |
| Provider Name | Emily Joy Riley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578867164 PECOS PAC ID: 6002256856 Enrollment ID: I20240427000032 |
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