| Ms Kelly Renee Mangold, CRNA | |
|
3 Scarlet Oak Ct, Lake St Louis, MO 63367-2130 | |
| (312) 919-6286 | |
| Not Available |
| Full Name | Ms Kelly Renee Mangold |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 17 Years |
| Location | 3 Scarlet Oak Ct, Lake St Louis, 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 |
|---|---|---|---|
| 1477876803 | NPI | - | NPPES |
| 600420070 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 2010005602 (Missouri) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 6708 (North Carolina) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Novamed Eye Surgery Center Of North County Llc | 6901866128 | 2 |
| Anesthesia Care Associates Llc | 6608042288 | 10 |
| Entity Name | Jefferson City Medical Group Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336189398 PECOS PAC ID: 1850371089 Enrollment ID: O20040908000924 |
| Entity Name | Dreamland Uap Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073919494 PECOS PAC ID: 9133442825 Enrollment ID: O20150105001419 |
| Entity Name | Novamed Eye Surgery Center Of North County Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003260100 PECOS PAC ID: 6901866128 Enrollment ID: O20160720002627 |
| Entity Name | Aim Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245685601 PECOS PAC ID: 3971896705 Enrollment ID: O20160801001265 |
| Entity Name | Northstar Anesthesia Of Missouri Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1396191789 PECOS PAC ID: 4082908249 Enrollment ID: O20160810001928 |
| Entity Name | Olde Cabin Anesthesia |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780228155 PECOS PAC ID: 8426489048 Enrollment ID: O20200515000838 |
| Entity Name | Cpr Anesthesia Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326436353 PECOS PAC ID: 7416272927 Enrollment ID: O20200625003307 |
| Entity Name | Anesthesia Stat Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467113357 PECOS PAC ID: 4385039346 Enrollment ID: O20220310000589 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Kelly Renee Mangold, CRNA 3 Scarlet Oak Ct, Lake St Louis, MO 63367-2130 Ph: (312) 919-6286 | Ms Kelly Renee Mangold, CRNA 3 Scarlet Oak Ct, Lake St Louis, MO 63367-2130 Ph: (312) 919-6286 |