| Mr Jeffrey Michael Ditter, NP | |
|
100 Medical Plz, Lake St Louis, MO 63367-1366 | |
| (636) 625-5200 | |
| (636) 625-5314 |
| Full Name | Mr Jeffrey Michael Ditter |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Location | 100 Medical Plz, Lake St Louis, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508307190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | A155084 (Iowa) | Secondary |
| 363L00000X | Nurse Practitioner | 2017004715 (Missouri) | Primary |
| Entity Name | Skaggs Community Hospital Association |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1861423683 PECOS PAC ID: 5092624320 Enrollment ID: O20040811000689 |
| Entity Name | Cole Physician Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144578659 PECOS PAC ID: 0648420810 Enrollment ID: O20121024000296 |
| Entity Name | Southeastern Physician Services Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083835441 PECOS PAC ID: 0042307852 Enrollment ID: O20160809000235 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Jeffrey Michael Ditter, NP 200 Corporate Blvd, Lafayette, LA 70508-3870 Ph: (800) 893-9698 | Mr Jeffrey Michael Ditter, NP 100 Medical Plz, Lake St Louis, MO 63367-1366 Ph: (636) 625-5200 |
Victoria Lynn Hines, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 Medical Plz, Lake St Louis, MO 63367 Phone: 636-625-5200 Fax: 636-625-5314 | |
Akiko Okabe, AGACNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 Medical Plz, Lake St Louis, MO 63367 Phone: 314-317-0600 Fax: 314-317-0606 | |
Molly Lombardo, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Medical Plz Ste 221, Lake St Louis, MO 63367 Phone: 636-625-6041 | |
Katie D Schmidt, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 300 Medical Plz Ste 150, Lake St Louis, MO 63367 Phone: 636-625-2662 | |
Yunhee Choi Cruse, CNP, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 Medical Plz, Lake St Louis, MO 63367 Phone: 636-625-5200 | |
Michelle Louise Wallweber, MSN, APRN, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 21 Meadows Circle Dr Ste 324, Lake St Louis, MO 63367 Phone: 636-389-2488 | |
Katherine Elizabeth Benenati, AGACNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 300 Medical Plz Ste 150, Lake St Louis, MO 63367 Phone: 636-625-2662 Fax: 636-625-1644 |