| Ameriwound Physicians Mo LLC | |
|
13700 Old Halls Ferry Rd Black Jack MO 63033-4109 | |
| (314) 355-0760 | |
| Not Available |
| Full Name | Ameriwound Physicians Mo LLC |
|---|---|
| Speciality | General Practice |
| Location | 13700 Old Halls Ferry Rd, Black Jack, Missouri |
| Authorized Official Name and Position | Samson Fixler (SECRETARY) |
| Authorized Official Contact | 2162739800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ameriwound Physicians Mo LLC 6150 Parkland Blvd Ste 225 Mayfield Hts OH 44124-4103 Ph: (216) 273-9800 | Ameriwound Physicians Mo LLC 13700 Old Halls Ferry Rd Black Jack MO 63033-4109 Ph: (314) 355-0760 |
| NPI Number | 1538046081 |
|---|---|
| Provider Enumeration Date | 08/18/2025 |
| Last Update Date | 08/18/2025 |
| Certification Date | 08/18/2025 |
| Medicare PECOS PAC ID | 2668962853 |
|---|---|
| Medicare Enrollment ID | O20251106001612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538046081 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| Provider Name | Diana a Prablek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588689541 PECOS PAC ID: 9335175066 Enrollment ID: I20050713000721 |
Chestnut Health of Missouri LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 13700 Old Halls Ferry Rd, Black Jack, MO 63033 Phone: 314-355-0760 Fax: 703-649-6188 |
Long Term Care of North County LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4401 Parker Rd, Black Jack, MO 63033 Phone: 314-312-0720 |