| Ly T Phan, MD | |
|
1601 E Broadway, Ste 240, Columbia, MO 65201-8020 | |
| (573) 815-8145 | |
| (573) 815-3832 |
| Full Name | Ly T Phan |
|---|---|
| Gender | Male |
| Speciality | General Surgery |
| Experience | 26 Years |
| Location | 1601 E Broadway, Columbia, 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 |
|---|---|---|---|
| 1356430870 | NPI | - | NPPES |
| 207505603 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 2005030724 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Cameron Regional Medical Center | Cameron, MO | Hospital |
| Harrison County Community Hospital | Bethany, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Cameron Regional Medical Center Inc | 5092622001 | 65 |
| Entity Name | Cameron Regional Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811905375 PECOS PAC ID: 5092622001 Enrollment ID: O20040113000619 |
| Entity Name | Missouri Delta Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508967860 PECOS PAC ID: 1355252891 Enrollment ID: O20040308001306 |
| Entity Name | Scotland County Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205844982 PECOS PAC ID: 8224940366 Enrollment ID: O20040923000249 |
| Entity Name | Poplar Bluff Hma Physician Management, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598710147 PECOS PAC ID: 5092769703 Enrollment ID: O20050307000013 |
| Entity Name | Skaggs Community Hospital Association |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1386708600 PECOS PAC ID: 5092624320 Enrollment ID: O20070219000034 |
| Entity Name | Harrison County Community Hospital District |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1528062569 PECOS PAC ID: 4587630926 Enrollment ID: O20071201000173 |
| Entity Name | Scotland County Memorial Hospital |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1083624647 PECOS PAC ID: 8224940366 Enrollment ID: O20140226001733 |
| Mailing Address | Practice Location Address |
|---|---|
| Ly T Phan, MD 670 Mason Ridge Center Dr, Ste 300, Saint Louis, MO 63141-8573 Ph: (573) 815-8145 | Ly T Phan, MD 1601 E Broadway, Ste 240, Columbia, MO 65201-8020 Ph: (573) 815-8145 |
Olivia Louise Bolles, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1 Hospital Dr, Columbia, MO 65212 Phone: 573-882-4141 | |
Ioan-andrei Scumpu, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1 Hospital Dr, Mchaney Hall 404, Dco75.00, Columbia, MO 65212 Phone: 573-884-2000 | |
Marc L Miller, DO Surgery Medicare: Accepting Medicare Assignments Practice Location: 115 Business Loop 70 W, Columbia, MO 65203 Phone: 573-882-8454 Fax: 573-884-6054 | |
Dr. Mary Carr, MD Surgery Medicare: Medicare Enrolled Practice Location: 800 Hospital Dr, Columbia, MO 65201 Phone: 573-814-6000 | |
Brent W Miedema, MD Surgery Medicare: Medicare Enrolled Practice Location: 800 Hospital Dr # 617, Columbia, MO 65201 Phone: 573-814-6346 | |
Dr. Kelley Marie Ray, MD Surgery Medicare: Medicare Enrolled Practice Location: 1 Hospital Dr, Columbia, MO 65212 Phone: 573-884-2000 | |
Thalia Catalina Anderson, MD Surgery Medicare: Medicare Enrolled Practice Location: 1 Hospital Dr, Columbia, MO 65212 Phone: 573-882-4141 |