| Mercy Clinic Child Neurology, Llc | |
|
621 S New Ballas Rd Suite 5009-b Saint Louis MO 63141-8232 | |
| (314) 251-5866 | |
| (314) 251-5867 |
| Full Name | Mercy Clinic Child Neurology, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 621 S New Ballas Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | John W. Hubert (PRESIDENT) |
| Authorized Official Contact | 3142511700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic Child Neurology, Llc 621 S New Ballas Rd Suite 5009-b Saint Louis MO 63141-8232 Ph: (314) 251-5866 | Mercy Clinic Child Neurology, Llc 621 S New Ballas Rd Suite 5009-b Saint Louis MO 63141-8232 Ph: (314) 251-5866 |
| NPI Number | 1285930206 |
|---|---|
| Provider Enumeration Date | 02/09/2011 |
| Last Update Date | 05/02/2014 |
| Medicare PECOS PAC ID | 8729234802 |
|---|---|
| Medicare Enrollment ID | O20120806000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285930206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | (* (Not Available)) | Primary |
| Provider Name | Katherine M Shine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427482157 PECOS PAC ID: 1850526005 Enrollment ID: I20131024001650 |
| Provider Name | Himanshu U Kaulas |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801186044 PECOS PAC ID: 6103120316 Enrollment ID: I20170803003257 |
| Provider Name | Ali A Jamal |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184980716 PECOS PAC ID: 0042514085 Enrollment ID: I20180709000210 |
| Provider Name | Srikanth Thalakoti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912132663 PECOS PAC ID: 6002038338 Enrollment ID: I20210802001112 |
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