| Altea Medical Missouri Llc | |
|
1441 Charic Dr Wildwood MO 63021-2001 | |
| (888) 408-7008 | |
| Not Available |
| Full Name | Altea Medical Missouri Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1441 Charic Dr, Wildwood, Missouri |
| Authorized Official Name and Position | Lisa Krueger (VP OF REVENUE CYCLE AND CONTRACTING) |
| Authorized Official Contact | 8884087008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altea Medical Missouri Llc 400 E Rivulon Blvd Ste 103 Gilbert AZ 85297-0096 Ph: () - | Altea Medical Missouri Llc 1441 Charic Dr Wildwood MO 63021-2001 Ph: (888) 408-7008 |
| NPI Number | 1649032608 |
|---|---|
| Provider Enumeration Date | 01/25/2024 |
| Last Update Date | 11/17/2025 |
| Medicare PECOS PAC ID | 0143768762 |
|---|---|
| Medicare Enrollment ID | O20240814002635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649032608 | NPI | - | NPPES |
| Provider Name | Jawed H Siddiqui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699705293 PECOS PAC ID: 5799762415 Enrollment ID: I20040701000288 |
| Provider Name | Andrea E Ivy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649220104 PECOS PAC ID: 7618930090 Enrollment ID: I20041106000029 |
| Provider Name | Kelli M Cash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225342876 PECOS PAC ID: 7416072780 Enrollment ID: I20100910000490 |
| Provider Name | Ruth Oluwaseun Ogunniyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356771729 PECOS PAC ID: 8527283076 Enrollment ID: I20140626000119 |
| Provider Name | Betsy L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538443072 PECOS PAC ID: 5991001976 Enrollment ID: I20160317001269 |
| Provider Name | Shelly Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881008498 PECOS PAC ID: 9436379237 Enrollment ID: I20160622002304 |
| Provider Name | Elizabeth Hudgins Maylack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154687077 PECOS PAC ID: 4082907191 Enrollment ID: I20180808003748 |
| Provider Name | Victoria Gelfand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558843755 PECOS PAC ID: 9638420078 Enrollment ID: I20180924001697 |
| Provider Name | Carmen Triguero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932663168 PECOS PAC ID: 7012334881 Enrollment ID: I20200826000438 |
| Provider Name | Chimnoya Nwagwu Youlo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1881910487 PECOS PAC ID: 2769613611 Enrollment ID: I20200930001385 |
| Provider Name | Okeyo Oghina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184003261 PECOS PAC ID: 9436218138 Enrollment ID: I20210805000433 |
| Provider Name | Sharonda A Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588324727 PECOS PAC ID: 2264824879 Enrollment ID: I20220111001691 |
| Provider Name | Tamica T Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891449013 PECOS PAC ID: 5890180426 Enrollment ID: I20220318000184 |
| Provider Name | Yuliya T Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699422683 PECOS PAC ID: 2860879954 Enrollment ID: I20220511000198 |
| Provider Name | Agnes Yahl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023089190 PECOS PAC ID: 4183651128 Enrollment ID: I20230710001117 |
| Provider Name | Jodhvir Sarai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972816718 PECOS PAC ID: 8628202124 Enrollment ID: I20240930002042 |
| Provider Name | Lacey C Sierra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154022275 PECOS PAC ID: 0648702852 Enrollment ID: I20241014000639 |
| Provider Name | Abisola E Abimbola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083440457 PECOS PAC ID: 8921535469 Enrollment ID: I20241223002718 |
| Provider Name | Lakesha Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043027519 PECOS PAC ID: 1254860240 Enrollment ID: I20250121000552 |
| Provider Name | Ramon Trinidad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588211627 PECOS PAC ID: 2860829355 Enrollment ID: I20250319001799 |
Mercy Clinic East Communities Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16555 Manchester Rd Ste 110, Wildwood, MO 63040 Phone: 636-405-3155 Fax: 636-405-3162 | |
Idim Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1909 Larimer Trl, Wildwood, MO 63011 Phone: 636-273-5311 | |
Wildwood Internal Medicine, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16759 Main Street, Suite 203, Wildwood, MO 63040 Phone: 636-458-4800 Fax: 636-594-7500 |