| Washington University Clinical Associates Blue Fish Llc | |
|
12360 Manchester Rd Suite 100 Saint Louis MO 63131-4312 | |
| (314) 966-8500 | |
| (314) 966-4499 |
| Full Name | Washington University Clinical Associates Blue Fish Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12360 Manchester Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Cathy Eghigian (DIRECTOR) |
| Authorized Official Contact | 3142730770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Washington University Clinical Associates Blue Fish Llc 12360 Manchester Rd Suite 100 Saint Louis MO 63131-4312 Ph: (314) 966-8500 | Washington University Clinical Associates Blue Fish Llc 12360 Manchester Rd Suite 100 Saint Louis MO 63131-4312 Ph: (314) 966-8500 |
| NPI Number | 1972912087 |
|---|---|
| Provider Enumeration Date | 08/04/2014 |
| Last Update Date | 12/03/2014 |
| Medicare PECOS PAC ID | 6002138666 |
|---|---|
| Medicare Enrollment ID | O20141210000253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972912087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Hayley M Wurzel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053456350 PECOS PAC ID: 2961724539 Enrollment ID: I20141210000855 |
| Provider Name | Jennifer L Arter |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1164499000 PECOS PAC ID: 0840512422 Enrollment ID: I20141210001033 |
| Provider Name | Adam C Eaton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366417750 PECOS PAC ID: 0648592220 Enrollment ID: I20141210001087 |
| Provider Name | Gregory K Finn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447223136 PECOS PAC ID: 5991027575 Enrollment ID: I20141210001168 |
| Provider Name | Jennifer A Grimmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548473879 PECOS PAC ID: 9133441728 Enrollment ID: I20141210001342 |
| Provider Name | Kelly D Wassel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225303522 PECOS PAC ID: 2769704352 Enrollment ID: I20141210001397 |
| Provider Name | Shawn R Reathaford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669572343 PECOS PAC ID: 4385664804 Enrollment ID: I20180111000066 |
| Provider Name | Marie Lynn Batty |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710407010 PECOS PAC ID: 0143642082 Enrollment ID: I20200622002147 |
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