| Vcphcs Xv, Llc | |
|
2919 E 4th St Joplin MO 64801-1625 | |
| (417) 782-7966 | |
| (417) 624-4558 |
| Full Name | Vcphcs Xv, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2919 E 4th St, Joplin, Missouri |
| Authorized Official Name and Position | Jemece Michelle Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vcphcs Xv, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Vcphcs Xv, Llc 2919 E 4th St Joplin MO 64801-1625 Ph: (417) 782-7966 |
| NPI Number | 1144666264 |
|---|---|
| Provider Enumeration Date | 05/15/2013 |
| Last Update Date | 02/21/2019 |
| Medicare PECOS PAC ID | 4486963345 |
|---|---|
| Medicare Enrollment ID | O20151016001032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144666264 | NPI | - | NPPES |
| Provider Name | Celeste Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689650855 PECOS PAC ID: 5991787608 Enrollment ID: I20040607000064 |
| Provider Name | Tabassum Saba |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427067230 PECOS PAC ID: 5890790042 Enrollment ID: I20060922000160 |
| Provider Name | Elaine Blevins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245471994 PECOS PAC ID: 0042351397 Enrollment ID: I20100108000150 |
| Provider Name | Kip C Newell |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1841226222 PECOS PAC ID: 8921131921 Enrollment ID: I20101014000908 |
| Provider Name | Devona D Gibbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215915889 PECOS PAC ID: 7810186962 Enrollment ID: I20110105001002 |
| Provider Name | Mark L Carlson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1528192150 PECOS PAC ID: 9739356239 Enrollment ID: I20120125000057 |
| Provider Name | Becky A Cumley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194966713 PECOS PAC ID: 6608193826 Enrollment ID: I20150327001849 |
| Provider Name | William Carpenter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164787594 PECOS PAC ID: 9032345400 Enrollment ID: I20151211000481 |
| Provider Name | Shawn M Stranckmeyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558776229 PECOS PAC ID: 4688946064 Enrollment ID: I20170818002923 |
| Provider Name | Sarah Marie Canoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639529746 PECOS PAC ID: 3274826557 Enrollment ID: I20200107001288 |
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