MERCY CLINIC BURN AND PLASTIC SURGERY, LLC (NPI# 1912037433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912037433 |
| Entity Type | Organization |
| Organization Name | MERCY CLINIC BURN AND PLASTIC SURGERY, LLC |
| Other Organization Name | MERCY BURN & PLASTIC SURGERY |
| Practice Address |
621 S. New Ballas Road Suite 7003-b St. Louis MO 63141-8275 |
| Practice Telephone | 3142515570 |
| Practice Fax Number | 3142515571 |
| Mailing Telephone | 3142515570 |
| Mailing Fax Number | 3142515571 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-11-19 |
| Authorized Official Name | JOHN W. HUBERT (PRESIDENT) |
| Authorized Official Telephone | 3142511700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | MERCY CLINIC EAST COMMUNITIES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 506063908 | 05 |
| Other Name | Type Code |
|---|---|
| Mercy Burn & Plastic Surgery | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15945 Clayton Rd Ste 305, Ballwin, MO 630112486 | 3142518750 | 3142515571 |
| 1820 Zumbehl Rd Ste 120, Saint Charles, MO 633032761 | 3142515570 | 3142515571 |
| 621 S New Ballas Rd Ste 7008b, Saint Louis, MO 631418275 | 3142518750 | 3142515571 |
| 901 Patients First Dr Ste 3200, Washington, MO 630904700 | 6362397727 | 6362395021 |
| Street Address |
621 S. NEW BALLAS ROAD SUITE 7003-B |
| City | ST. LOUIS |
| State | MO |
| Zip Code | 63141-8275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942532445 | Nicole Shuert | Nurse Practitioner | 621 S. New Ballas Road, Suite 4017 Tower B, St. Louis, MO 63141 | 2010-02-08 |
| 1649349804 | Mercy Clinic Children's Surgery, LLC | Surgery | 621 S. New Ballas Road, Suite 6018-b, St. Louis, MO 63141-8274 | 2006-11-06 |
| 1386739548 | Ronald E. Haake | Internal Medicine | 621 S. New Ballas Road, Suite 4006-b, St. Louis, MO 63141 | 2006-10-04 |
| 1922191584 | Theodore G. Sample Jr. | Pediatrics | 621 S. New Ballas Road, Suite 6009-b, St. Louis, MO 63141 | 2006-10-02 |
| 1700995339 | David Alan Janssen | Specialist | 621 S. New Ballas Road, Suite 70 Tower B, St. Louis, MO 63141 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821198607 | Melvin Marlow Maclin II | Surgery | 845 North New Ballas Road, Suite 300, St. Louis, MO 63141-7083 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285126060 | Ameya Atul Chumble | Surgery | 1 Hospital Dr Rm M349, Columbia, MO 65212-1000 | 2018-06-06 |
| 1689103053 | Angela Hulsey | Surgery | 1 Hospital Dr # M349, Columbia, MO 65212-1000 | 2017-06-08 |
| 1265813950 | Brandon Lambiris | Surgery | 1 Hospital Dr # Dc064.00, Division of Plastic Surgery, Columbia, MO 65212-1000 | 2015-06-18 |
| 1972923126 | Rafi Fredman | Surgery | 1551 Wall St Ste 420, Saint Charles, MO 63303-3541 | 2014-04-25 |
| 1497096820 | Ali A Arbab | Surgery | 10316 Prairie View Road, Kansas City, MO 64153 | 2013-03-11 |
| 1871781765 | Andrew J Kochevar | Surgery | 1229 E Seminole St Ste 340, Springfield, MO 65804 | 2007-10-04 |
| 1154527190 | Jonathan Amspacher | Surgery | 5204 N Belt Hwy, Saint Joseph, MO 64506-1211 | 2007-06-26 |
| 1073676755 | Parkcrest Plastic Surgery, Inc. | Surgery | 845 N. New Ballas Court, Suite 300, Saint Louis, MO 63141-7083 | 2006-12-18 |
| 1992895312 | Jeffrey A Goldstein | Surgery | 2401 Gilham Avenue, Kansas City, MO 64108 | 2006-10-14 |
| 1164536710 | Brock Davis Ridenour | Surgery | 12460 Olive Blvd, Suite 202, Saint Louis, MO 63141-6409 | 2006-08-19 |
| 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.