MIA OF ST CHARLES COUNTY LLC (NPI# 1922093632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922093632 |
| Entity Type | Organization |
| Organization Name | MIA OF ST CHARLES COUNTY LLC |
| Other Organization Name | CLINICAL PET OF ST CHARLES COUNTY |
| Practice Address |
1475 Kisker Rd Ste 145 Saint Charles MO 63304-8781 |
| Mailing Address |
Po Box 868 Edwardsville IL 62025-0868 |
| Practice Telephone | 6369225151 |
| Practice Fax Number | 6369225454 |
| Mailing Telephone | 6186591167 |
| Mailing Fax Number | 6186591197 |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. STEVEN MICHAEL MCRAE (MANAGING MEMBER) |
| Authorized Official Telephone | 6186591167 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Clinical PET of St Charles County | Doing Business As Name - Organization |
| Street Address |
1475 KISKER RD STE 145 |
| City | SAINT CHARLES |
| State | MO |
| Zip Code | 63304-8781 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245238401 | Melanie Nicole Pilkenton | Physician Assistant | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2005-07-12 |
| 1487253662 | Lindsay Tyree | Physical Therapist | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2020-10-20 |
| 1144714023 | Cecelia Pratt | Registered Nurse | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2018-06-14 |
| 1558891747 | Katie Mocca | Physical Therapist | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2017-06-19 |
| 1801348339 | Lindsey Catherine Martin | Registered Nurse | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2016-11-01 |
| 1083168801 | Forefront Dermatology, S.c. | Dermatology | 1475 Kisker Rd, Suite 270, Saint Charles, MO 63304 | 2016-08-10 |
| 1528421260 | Ssm St. Charles Clinic Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 1475 Kisker Rd, Suite 200, Saint Charles, MO 63304-8781 | 2016-03-31 |
| 1841663747 | Michelle L Wolynski | Nurse Practitioner | 1475 Kisker Rd, Suite 200, Saint Charles, MO 63304-8781 | 2015-11-02 |
| 1558733113 | Melissa Irvine | Nurse Practitioner | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2015-10-22 |
| 1558750364 | Jade Holman | Nurse Practitioner | 1475 Kisker Rd, Saint Charles, MO 63304-8781 | 2015-01-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382127 | Susan Brockmeyer | Occupational Therapist | 600 Breeze View Ln, Weldon Springs, MO 63304 | 2020-09-29 |
| 1235743097 | Brett Allan Lancaster | Pharmacist | 3801 Old Highway 94, St. Peters, MO 63304 | 2020-08-31 |
| 1356834683 | Emily Elizabeth Blau | Chiropractor | 5055 State Highway N, 108, Cottleville, MO 63304 | 2018-06-12 |
| 1033606769 | Christina Marie Crain | Counselor | 501 Chele Dr, Saint Charles, MO 63304 | 2018-04-18 |
| 1063875532 | Amy L Ney-carder | Speech-Language Pathologist | 5199 State Highway N, St. Peters, MO 63304 | 2016-04-01 |
| 1609127745 | Lawlor Chiropractic LLC | Chiropractor | 6028 Weldon Spring Parkway, Weldon Spring, MO 63304 | 2012-09-28 |
| 1043588510 | Esther Lima | Pharmacist | 3801 S Harvester Rd, St Peters, MO 63304 | 2011-12-12 |
| 1922318245 | Sonya Paramore | Counselor | 1480 Woodstone Drive, Suite 211, Saint Charles, MO 63304 | 2010-10-20 |
| 1871624445 | Joylynn Anderson | Social Worker | 5931 Highway 94 South, Saint Charles, MO 63304 | 2007-03-08 |
| 1821155706 | Cynthia Lynn Sitarski | Occupational Therapist | 4545 Central School Road, St. Charles, MO 63304 | 2007-01-02 |
| Find all providers in zip 63304 | ||||
| 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). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982035440 | Ezell Chiropractic LLC | Clinic/Center | 1817 Zumbehl Rd, Saint Charles, MO 63303-2728 | 2013-12-10 |
| 1215563374 | Rafi Fredman Md LLC | Clinic/Center | 1551 Wall St Ste 420, Saint Charles, MO 63303-3541 | 2020-03-20 |
| 1417418583 | Healing Hand Health, Lc | Clinic/Center | 2061 Collier Corporate Pkwy, Saint Charles, MO 63303-6701 | 2019-03-29 |
| 1811244387 | Eye Shoppe, Inc. | Clinic/Center | 115 N Main St, Saint Charles, MO 63301-2826 | 2012-08-14 |
| 1528327921 | Lance Hatch | Clinic/Center | 1575 Kisker Rd, Saint Charles, MO 63304-0608 | 2012-05-07 |
| 1477826030 | Complete Wellness Chiropractic Center LLC | Clinic/Center | 2241 Bluestone Dr, Saint Charles, MO 63303-6705 | 2012-02-13 |
| 1790001139 | Amaranth Counseling, LLC | Clinic/Center | 2230 Bluestone Dr, Saint Charles, MO 63303-5978 | 2010-04-09 |
| 1346494226 | Wilks Chiropractic | Clinic/Center | 2241 Bluestone Dr, Saint Charles, MO 63303-6705 | 2008-11-05 |
| 1104091958 | Lauer Chiropractic PC | Clinic/Center | 2241 Bluestone Dr, Saint Charles, MO 63303-6705 | 2008-04-23 |
| 1265556369 | Fox Valley Wellness Center, Ltd | Clinic/Center | 2325 Dean St, Suite 400, Saint Charles, IL 60175-4810 | 2007-03-16 |
| Find all providers in SAINT CHARLES | ||||
| City | SAINT CHARLES |
| Zip Code | 63304 |
Please comment or provide details below to improve the information on MIA OF ST CHARLES COUNTY LLC.
| 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.