| Sevi Life Llc | |
|
300 Saint Peters Centre Blvd Ste 250 Saint Peters MO 63376-1662 | |
| (636) 245-5126 | |
| (636) 245-3235 |
| Full Name | Sevi Life Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 300 Saint Peters Centre Blvd Ste 250, Saint Peters, Missouri |
| Authorized Official Name and Position | Marizelle Flores (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8609444766 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sevi Life Llc 300 Saint Peters Centre Blvd Ste 250 Saint Peters MO 63376-1662 Ph: (636) 245-5126 | Sevi Life Llc 300 Saint Peters Centre Blvd Ste 250 Saint Peters MO 63376-1662 Ph: (636) 245-5126 |
| NPI Number | 1770331761 |
|---|---|
| Provider Enumeration Date | 05/07/2024 |
| Last Update Date | 02/06/2025 |
| Medicare PECOS PAC ID | 2668905647 |
|---|---|
| Medicare Enrollment ID | O20241029003486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770331761 | NPI | - | NPPES |
| Provider Name | Piyush Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780945212 PECOS PAC ID: 6305063330 Enrollment ID: I20241029003662 |
| Provider Name | Ryan Wade |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588027403 PECOS PAC ID: 5496173338 Enrollment ID: I20241029003792 |
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