IMAGING CENTER AT WOLF CREEK LLC (NPI# 1285629097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285629097 |
| Entity Type | Organization |
| Organization Name | IMAGING CENTER AT WOLF CREEK LLC |
| Practice Address |
12 Wolf Creek Dr Swansea IL 62226-2343 |
| Mailing Address |
Po Box 868 Edwardsville IL 62025-0868 |
| Practice Telephone | 6182777912 |
| Practice Fax Number | 6182777915 |
| Mailing Telephone | 6186591167 |
| Mailing Fax Number | 6186591197 |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2007-07-08 |
| Authorized Official Name | MR. STEVEN MICHAEL MCRAE (MANAGING MEMBER) |
| Authorized Official Telephone | 6186191167 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
12 WOLF CREEK DR |
| City | SWANSEA |
| State | IL |
| Zip Code | 62226-2343 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912903394 | Angela D Wuebbels | Physical Therapist | 12 Wolf Creek Dr, Ste 200, Swansea, IL 62226-2343 | 2005-06-22 |
| 1659805513 | Katherine E House | Nurse Practitioner | 12 Wolf Creek Dr, Suite 200, Swansea, IL 62226-2314 | 2017-04-18 |
| 1306148622 | Kari Diane Roberts | Physical Therapist | 12 Wolf Creek Dr, Swansea, IL 62226-2314 | 2010-11-18 |
| 1235467606 | Associated Physicians Group Ltd | Specialist | 12 Wolf Creek Dr, Suite 200, Swansea, IL 62226-2314 | 2009-11-24 |
| 1952355786 | John A Mattingly | Radiology | 12 Wolf Creek Dr, Swansea, IL 62226-2314 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1053969790 | Consistent Medical Transportation | Driver | 2012 N 17th St, Swansea, IL 62226 | 2019-08-27 |
| 1497314371 | Medi-plex Hospice of Illinois, LLC | Registered Nurse | 8 Park Place, Suite #3, Swansea, IL 62226 | 2019-06-13 |
| 1336617364 | Nicole Renee Schmidt | Speech-Language Pathologist | 150 N 27th St., Belleville, IL 62226 | 2018-11-07 |
| 1295258903 | Catherine Espino | Pharmacist | 11 Chambers Blvd, Swansea, IL 62226 | 2017-07-25 |
| 1366806838 | Kiley Faires | Nurse Practitioner | 4600 Memorial Drive Ste 360, Belleville, IL 62226 | 2016-04-11 |
| 1760857585 | Mvp Transportation | Non-emergency Medical Transport (VAN) | 1229 N 17th Street, Number 23, Belleville, IL 62226 | 2015-12-04 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1396168332 | Jayne E. Ninness | Physical Therapy Assistant | 4500 Memorial Dr., Memorial Hospital, Belleville, IL 62226 | 2014-01-28 |
| 1053758193 | Gateway Foundation, Inc. | Clinic/Center | 1 Bronze Point, Suite 1, Swansea, IL 62226 | 2013-05-30 |
| Find all providers in zip 62226 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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|---|---|---|---|---|
| 1154871408 | Back Into Balance, Inc | Clinic/Center | 1211 Gar Hwy, Swansea, MA 02777-4225 | 2016-10-11 |
| 1902053481 | Digitrace Care Services, Inc | Clinic/Center | 1010 Gar Hwy, Unit 2, 1st Floor, Swansea, MA 02777 | 2008-08-26 |
| 1619150703 | Ssm Medical Group | Clinic/Center | 3 Park Pl, Swansea, IL 62226-2965 | 2007-12-11 |
| 1730105735 | Lexington County Health Services District, Inc. | Clinic/Center | 935 West 2nd Street, Swansea, SC 29160 | 2006-07-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.