| Family Medicine - Slmg South, Llc | |
| 
					1501 Professional Dr Imperial MO 63052-3809  | |
| (636) 464-4000 | |
| (636) 529-0699 | 
| Full Name | Family Medicine - Slmg South, Llc | 
|---|---|
| Speciality | Family Medicine | 
| Location | 1501 Professional Dr, Imperial, Missouri | 
| Authorized Official Name and Position | James Snider (VP PHYSICIAN NETWORK) | 
| Authorized Official Contact | 6366857804 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Family Medicine - Slmg South, Llc 121 Saint Lukes Center Dr Chesterfield MO 63017-3518 Ph: (636) 685-7804  | Family Medicine - Slmg South, Llc 1501 Professional Dr Imperial MO 63052-3809 Ph: (636) 464-4000  | 
| NPI Number | 1164077822 | 
|---|---|
| Provider Enumeration Date | 08/08/2019 | 
| Last Update Date | 10/21/2020 | 
| Medicare PECOS PAC ID | 3971833443 | 
|---|---|
| Medicare Enrollment ID | O20190925003479 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1164077822 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary | 
| Provider Name | Nicole E Baker | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1235340332 PECOS PAC ID: 6204908007 Enrollment ID: I20080711000086  | 
| Provider Name | Jodi C Green | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1679730576 PECOS PAC ID: 1153496179 Enrollment ID: I20080826000303  | 
| Provider Name | Patrick R Smith | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1093715096 PECOS PAC ID: 4385711886 Enrollment ID: I20080925000331  | 
| Provider Name | Patricia L Pitman | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1083915771 PECOS PAC ID: 1153519061 Enrollment ID: I20101220000444  | 
| Provider Name | Dawn M Forbes | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1457637811 PECOS PAC ID: 5597930453 Enrollment ID: I20111205000904  | 
| Provider Name | Katherine E Clancy | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1568724284 PECOS PAC ID: 3678738242 Enrollment ID: I20120705000151  | 
| Provider Name | Kelly A Gill | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1487078879 PECOS PAC ID: 5193956944 Enrollment ID: I20140320001647  | 
| Provider Name | Natalie R Eads | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1356731004 PECOS PAC ID: 0345566410 Enrollment ID: I20150309000342  | 
| Provider Name | Julie A Godefroid | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1437524360 PECOS PAC ID: 6608174909 Enrollment ID: I20160420001278  | 
| Provider Name | Melissa Ann Muench | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1104266733 PECOS PAC ID: 0244536837 Enrollment ID: I20160718000234  | 
| Provider Name | Cynthia S Anthonies | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1508384942 PECOS PAC ID: 6608134168 Enrollment ID: I20171212000097  | 
| Provider Name | Kimberli L Campbell | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1861991994 PECOS PAC ID: 7618237595 Enrollment ID: I20180214002670  | 
| Provider Name | Jacqueline Michelle Block | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1871064972 PECOS PAC ID: 1951649656 Enrollment ID: I20190205000413  | 
| Provider Name | Cassandra Strothkamp | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1013568013 PECOS PAC ID: 3072948538 Enrollment ID: I20200111000086  | 
| Provider Name | Rebecca A Michels | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1184144065 PECOS PAC ID: 2365712890 Enrollment ID: I20201125002468  | 
| Provider Name | Christa Jane Morgan | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1922735554 PECOS PAC ID: 1355718446 Enrollment ID: I20221102001333  | 
| Provider Name | Ashley Danielle Nator | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1740997527 PECOS PAC ID: 5395113617 Enrollment ID: I20221117001679  | 
| Provider Name | Lori Ann Orso | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1952084873 PECOS PAC ID: 4284079203 Enrollment ID: I20240229003148  | 
| Provider Name | Tabitha Marie Braun | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1174381701 PECOS PAC ID: 6305283490 Enrollment ID: I20240325003394  | 
| Provider Name | Max A Hesse | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1679142772 PECOS PAC ID: 3375948334 Enrollment ID: I20240816003161  | 
| Provider Name | Christina Jane Linsenbardt | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1144032285 PECOS PAC ID: 2264961697 Enrollment ID: I20250129002447  | 
| Provider Name | Elizabeth Erin Jones | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1790528289 PECOS PAC ID: 2365964871 Enrollment ID: I20250313001926  | 
Celso F Rodrigues Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2674 Fox Run Dr, Imperial, MO 63052 Phone: 636-461-2711 Fax: 636-461-0786  | |
Patterson Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1502 Prehistoric Hill Dr, Imperial, MO 63052 Phone: 636-464-4000 Fax: 636-464-4911  |