ICARE PRIMARY CARE CLINIC, LLC (NPI# 1699173757) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699173757 |
| Entity Type | Organization |
| Organization Name | ICARE PRIMARY CARE CLINIC, LLC |
| Practice Address |
550 Rush Creek Pkwy Suite B Liberty MO 64068-9608 |
| Practice Telephone | 8168754325 |
| Practice Fax Number | 6362378053 |
| Mailing Telephone | 8168754325 |
| Mailing Fax Number | 6362378053 |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2014-12-05 |
| Authorized Official Name | DR. ERIK CHRISTIAN PETERSEN (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 8168754325 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | FL001411027 | MO | Residential Treatment Facilities |
| Street Address |
550 RUSH CREEK PKWY SUITE B |
| City | LIBERTY |
| State | MO |
| Zip Code | 64068-9608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437159217 | Thomas Craig Boldry | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| 1316344658 | Icare Primary Care | Exclusive Provider Organization | 550 Rush Creek Pkwy, Suite B, Liberty, MO 64068-9608 | 2014-12-02 |
| 1396075743 | Matthew Dean Nielsen | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9604 | 2010-01-07 |
| 1194762930 | Liberty Medicine Specialists, Inc. | Internal Medicine | 550 Rush Creek Pkwy, Ste B, Liberty, MO 64068-9604 | 2006-06-01 |
| 1801896600 | Julie Jeanette Jones | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| 1629078407 | Paul Owen Gorby | Podiatrist | 550 Rush Creek Pkwy, Suite A, Liberty, MO 64068-9608 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437258 | Midwestern Medical Consultants LLC | Assisted Living Facility | 227 W. Franklin St, Liberty, MO 64068 | 2019-09-26 |
| 1063935062 | Jennifer Nichole Gibson | Nurse Practitioner | Liberty Hospital 2525 Glen Hendren Dr, Liberty, MO 64068 | 2017-07-21 |
| 1598288755 | Lhlc Operations, LLC | Skilled Nursing Facility | 2609 Glenn Hendren Dr Ste G100, Liberty, MO 64068 | 2017-07-19 |
| 1023438371 | Sarah E Ehlers | Social Worker | 1170 W. Kansas Ave, Bldg 10, Liberty, MO 64068 | 2014-04-24 |
| 1629498563 | Kelli Hedgpeth | Physical Therapy Assistant | 3980 South Jackson Dr, Independence, MO 64068 | 2014-04-18 |
| 1639593965 | Klein Dental Group LLC | Clinic/Center | 12 Westwoods Dr, Liberty, MO 64068 | 2014-02-06 |
| 1124457239 | Sarah Ehlers, Lcsw LLC | Social Worker | 1170 W Kansas Ave, Bldg 10, Liberty, MO 64068 | 2013-11-08 |
| 1134561558 | Holly Hemphill | Marriage & Family Therapist | 117 N. Water Street, Liberty, MO 64068 | 2013-07-26 |
| 1093157133 | Tina Wilma Sanborn | Marriage & Family Therapist | 1170 W. Kansas St., Liberty, MO 64068 | 2013-07-17 |
| 1609215441 | Timothy Adam Lynch | Marriage & Family Therapist | 1170 West Kansas Ave., Liberty, MO 64068 | 2013-06-14 |
| Find all providers in zip 64068 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073112967 | Hurdler Outreach Services LLC | Substance Abuse Rehabilitation Facility | 6425 Evanston Ave, Raytown, MO 64133-4931 | 2020-10-21 |
| 1912529041 | Ip Reserve | Substance Abuse Rehabilitation Facility | 21708 Nickel Ave, Gallatin, MO 64640-6369 | 2020-05-12 |
| 1417577107 | Sana Lake Recovery Center, LLC | Substance Abuse Rehabilitation Facility | 150 Sana Lake Recovery Way, Dittmer, MO 63023 | 2020-04-22 |
| 1639723463 | Haven Recovery Homes | Substance Abuse Rehabilitation Facility | 3929 Michigan Ave, Saint Louis, MO 63118-4324 | 2019-07-30 |
| 1356875678 | Summit Bhc Saint Louis, LLC | Substance Abuse Rehabilitation Facility | 22933 Hwy 61, Eolia, MO 63344 | 2017-04-13 |
| 1821549122 | Preferred Family Healthcare, Inc | Substance Abuse Rehabilitation Facility | 2415 W Catalpa St, Springfield, MO 65807-1123 | 2016-10-21 |
| 1225496052 | Betty Lou Wallace Recovery LLC | Substance Abuse Rehabilitation Facility | 13350 Holmes Rd, Kansas City, MO 64145-1437 | 2016-02-08 |
| 1326414350 | Synergy Recovery Center | Substance Abuse Rehabilitation Facility | 3955 S Farm Road 223, Rogersville, MO 65742-8807 | 2015-08-13 |
| 1821406174 | Preferred Family Healthcare, Inc | Substance Abuse Rehabilitation Facility | 4066 Dunnica, Saint Louis, MO 63118 | 2014-07-31 |
| 1932517653 | Summit Bhc Lafayette LLC | Substance Abuse Rehabilitation Facility | 551 Warren Ave, Saint Louis, MO 63130-4155 | 2014-07-25 |
| Find all providers with the same taxonomy | ||||
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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.