MARYVILLE WOMENS CENTER SSR PC (NPI# 1427416494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427416494 |
| Entity Type | Organization |
| Organization Name | MARYVILLE WOMENS CENTER SSR PC |
| Practice Address |
2016 Vadalabene Dr Suite B Maryville IL 62062-6901 |
| Practice Telephone | 6182882970 |
| Practice Fax Number | 6182883572 |
| Mailing Telephone | 6182882970 |
| Mailing Fax Number | 6182883572 |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2016-02-05 |
| Authorized Official Name | KIMBERLY N SANFORD (OWNER) |
| Authorized Official Telephone | 6182882970 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 367A00000X | Advanced Practice Midwife | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Street Address |
2016 VADALABENE DR SUITE B |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-6901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194710905 | Open Mri of Southern Illinois LLC | Clinic/Center | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2005-09-19 |
| 1255805594 | Sara Marie Grotefendt | Nurse Practitioner | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2019-01-21 |
| 1356857171 | Maryville Womens Center PC | Obstetrics & Gynecology | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2017-12-15 |
| 1801339965 | Msa Alliance, LLC | Surgery | 2016 Vadalabene Dr, Suite B, Maryville, IL 62062-6901 | 2016-11-22 |
| 1184176612 | Robin Turner-viviano | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2016-11-01 |
| 1902252174 | Brittany Pierson, LLC | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2016-05-06 |
| 1912366436 | Kacey Panyik | Advanced Practice Midwife | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2016-02-11 |
| 1639429376 | Brittany N Pierson | Counselor | 2016 Vadalabene Dr, Suite A, Maryville, IL 62062-6901 | 2012-09-10 |
| 1609018175 | Foley Dental Group, LLC | Dentist | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2009-03-30 |
| 1932357472 | Diana Lynn Herrick | Nurse Practitioner | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2008-09-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760965982 | Women's Care Group Pllc | Obstetrics & Gynecology | 270 Bmh Physician Office Building, Physicians Office Building, Maryville, TN 37804-3780 | 2018-09-13 |
| 1255727301 | Bryson Whalen | Obstetrics & Gynecology | 6812 State Route 162 Ste 301, Maryville, IL 62062-8562 | 2015-04-15 |
| 1922307115 | Erin Michal Wright | Obstetrics & Gynecology | 6810 State Route 162 Ste 215, Maryville, IL 62062-8566 | 2011-03-28 |
| 1154481364 | Patrice Staten | Obstetrics & Gynecology | 6810 State Route 162 Suite 105, Maryville, IL 62062-8501 | 2006-12-11 |
| 1326057381 | Elizabeth D Lebrun | Obstetrics & Gynecology | 1033 E Lamar Alexander Pkwy, Maryville, TN 37804 | 2006-08-07 |
| 1033172481 | Gary Merlin Mason | Obstetrics & Gynecology | 1503 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2006-04-07 |
| 1649232513 | Dale Bryant Elmore | Obstetrics & Gynecology | 417 E Lamar Alexander Pkwy, Maryville, TN 37804-5807 | 2006-04-05 |
| 1548238785 | John C Mcamis | Obstetrics & Gynecology | 1029 E Lamar Alexander Pkwy, Maryville, TN 37804-5134 | 2006-03-14 |
| 1306825856 | Christina L Midkiff | Obstetrics & Gynecology | 2023 Vadalabene Dr, Ste 200, Maryville, IL 62062-5631 | 2006-01-12 |
| 1356857171 | Maryville Womens Center PC | Obstetrics & Gynecology | 2016 Vadalabene Dr, Maryville, IL 62062-6901 | 2017-12-15 |
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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.