| Dr Russell D Deidiker, MD | |
|
1212 Weber Rd, Suite 205, Farmington, MO 63640-3325 | |
| (573) 756-4581 | |
| (573) 756-7197 |
| Full Name | Dr Russell D Deidiker |
|---|---|
| Gender | Male |
| Speciality | Pathology |
| Experience | 35 Years |
| Location | 1212 Weber Rd, Farmington, Missouri |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841265345 | NPI | - | NPPES |
| 208729707 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | 113238 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Missouri Delta Medical Center | Sikeston, MO | Hospital |
| Parkland Health Center | Farmington, MO | Hospital |
| Saint Francis Medical Center | Cape girardeau, MO | Hospital |
| Southeasthealth | Cape girardeau, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mid-america Pathology Consultants, Llc | 0648569210 | 2 |
| Entity Name | Southeast Missouri Hospital Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558311522 PECOS PAC ID: 9133024334 Enrollment ID: O20031201000775 |
| Entity Name | American Multispecialty Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1972559532 PECOS PAC ID: 1658365572 Enrollment ID: O20040413001412 |
| Entity Name | Mid-america Pathology Consultants, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1194193326 PECOS PAC ID: 0648569210 Enrollment ID: O20160520001258 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Russell D Deidiker, MD 312 Louise St, Farmington, MO 63640-2706 Ph: (573) 756-4581 | Dr Russell D Deidiker, MD 1212 Weber Rd, Suite 205, Farmington, MO 63640-3325 Ph: (573) 756-4581 |
Muhammad Hanif Pathan, MD Pathology Medicare: Accepting Medicare Assignments Practice Location: 1101 W Liberty St, Farmington, MO 63640 Phone: 573-756-6451 |