WALESKA LARICE


Address: 1015 Bowles Ave, Fenton, MO 63026
Phone: 6364962000

WALESKA LARICE (NPI# 1972827830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
2345 Dougherty Ferry Rd, Saint Louis, MO 631223313 3149669100
4007 Estate Diamond Ruby, Christiansted, VI 008204435 3407786311 3407727387

Office Location

Street Address 1015 BOWLES AVE
City FENTON
State MO
Zip Code 63026

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207PE0004X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine
Specialization Emergency Medical Services

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1144251679 Akeeb Adedokun Emergency Medicine 5058 Romaine Spring Dr, Fenton, MO 63026-5868 2006-07-05

Providers in the same taxonomy and state

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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Competitor

Search similar providers

City FENTON
Zip Code 63026

Improve Information

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Dataset Information

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.

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