WALESKA LARICE (NPI# 1972827830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1972827830 |
Entity Type | Individual |
Full Name | WALESKA LARICE |
Credential | M.D. |
Practice Address |
1015 Bowles Ave Fenton MO 63026 |
Mailing Address |
58 Chesterfield Lakes Rd Chesterfield MO 63005-4522 |
Practice Telephone | 6364962000 |
Mailing Telephone | 6364852569 |
Enumeration Date | 2010-03-22 |
Last Update Date | 2018-09-12 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
2013020319 | MO | Allopathic & Osteopathic Physicians |
N | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
2479 | VI | Allopathic & Osteopathic Physicians |
N | 207Q00000X | Family Medicine | 036134631 | IL | Allopathic & Osteopathic Physicians |
N | 207Q00000X | Family Medicine | ME117446 | FL | Allopathic & Osteopathic Physicians |
N | 207Q00000X | Family Medicine | 2013020319 | MO | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
2345 Dougherty Ferry Rd, Saint Louis, MO 631223313 | 3149669100 | |
4007 Estate Diamond Ruby, Christiansted, VI 008204435 | 3407786311 | 3407727387 |
Street Address |
1015 BOWLES AVE |
City | FENTON |
State | MO |
Zip Code | 63026 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982687059 | Robert Brunton Smith | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2005-11-22 |
1235756149 | Megan Poucher | Student in an Organized Health Care Education/Training Program | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2020-06-26 |
1598389306 | Andrew Richardson | Nurse Anesthetist, Certified Registered | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2020-06-08 |
1538714688 | Galen Inpatient Physicians Inc. | Internal Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2019-08-06 |
1093360414 | Cep America LLC | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2019-08-02 |
1427525468 | Paige Cathleen Hagen | Pharmacist | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2018-10-29 |
1700303765 | Anne M Reeb | Dietitian, Registered | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2017-08-29 |
1851828297 | Erin Fagan | Occupational Therapist | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2017-05-16 |
1437681418 | Matthew Schwab | Emergency Medicine | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2017-03-30 |
1144678285 | Wilka Yaneth Vincent | Dietitian, Registered | 1015 Bowles Ave, Fenton, MO 63026-2394 | 2016-05-31 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
Find all providers in zip 63026 |
Taxonomy Code | 207PE0004X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Emergency Medicine |
Specialization | Emergency Medical Services |
An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144251679 | Akeeb Adedokun | Emergency Medicine | 5058 Romaine Spring Dr, Fenton, MO 63026-5868 | 2006-07-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962777557 | Blue Springs Emergency Physician Services PC | Emergency Medicine | 201 Nw Rd Mize Road, Blue Springs, MO 64014 | 2012-03-14 |
1225160179 | William F Bowman | Emergency Medicine | Heartland Regional Medical Center, 5325 Faraon St, St. Joseph, MO 64506 | 2007-03-09 |
1750434999 | Luis Robles | Emergency Medicine | 529 Southwest Blvd, Kansas City, MO 64108-2122 | 2007-01-19 |
1134215759 | Guy R Kline | Emergency Medicine | 6141 Oak Creek Dr, Osage Beach, MO 65065-2571 | 2006-10-04 |
1053413542 | Michael Eligio Fritsche | Emergency Medicine | 625 Bemis Heights Pl, Saint Charles, MO 63303-1752 | 2006-09-04 |
1598700684 | Raana J Ponstingl | Emergency Medicine | 3635 Vista At Grand Boulevard, Saint Louis, MO 63110 | 2006-06-20 |
1740264670 | Pamela Westerling | Emergency Medicine | 230 Tompkins Court, Troy, MO 63379 | 2005-12-05 |
1104432640 | Complex Healthcare of Des Peres LLC | Emergency Medicine | 1032 Old Des Peres Rd, Saint Louis, MO 63131-1865 | 2020-09-21 |
1003337858 | William Kells Boland | Emergency Medicine | 1 Barnes-jewish Hospital Plaza, St. Louis, MO 63110 | 2017-07-02 |
1154703841 | Preston Mangum Gilbert | Emergency Medicine | 2345 Dougherty Ferry Rd, Saint Louis, MO 63122-3313 | 2015-06-18 |
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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.