| Theresa Katherine Mattingly, MD | |
|
3265 Ne Ralph Powell Rd, Lees Summit, MO 64064-2301 | |
| (816) 524-4747 | |
| (816) 524-4929 |
| Full Name | Theresa Katherine Mattingly |
|---|---|
| Gender | Female |
| Speciality | Dermatology |
| Experience | 12 Years |
| Location | 3265 Ne Ralph Powell Rd, Lees Summit, Missouri |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265849053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207N00000X | Dermatology | 125064953 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Southeasthealth | Cape girardeau, MO | Hospital |
| Saint Francis Medical Center | Cape girardeau, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Advanced Dermatology Of Southeast Missouri Pc | 3678612108 | 9 |
| Entity Name | Dermatology And Skin Cancer Specialists Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366632697 PECOS PAC ID: 5294721486 Enrollment ID: O20040422001277 |
| Entity Name | Advanced Dermatology Of Southeast Missouri Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770713950 PECOS PAC ID: 3678612108 Enrollment ID: O20091123000348 |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa Katherine Mattingly, MD 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064-2301 Ph: (816) 524-4747 | Theresa Katherine Mattingly, MD 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064-2301 Ph: (816) 524-4747 |
Nicholas Joseph Golda, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064 Phone: 913-907-2496 | |
Julie Ann Green, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064 Phone: 913-451-7546 Fax: 816-524-4929 | |
Grant Jeffrey Randall, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 601 Nw Obrien Rd, Lees Summit, MO 64063 Phone: 816-287-1528 Fax: 343-503-0640 | |
Araya Zaesim, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064 Phone: 816-454-3424 | |
Sheldon Sebastian, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3265 Ne Ralph Powell Rd, Lees Summit, MO 64064 Phone: 816-524-4747 Fax: 816-524-4929 | |
David Ryan Fieleke, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1728 Ne Nine Oaks Dr, Lees Summit, MO 64086 Phone: 573-356-7265 |