| Jay Mahadevan Inc | |
|
3535 S Jefferson Ave Suite 304 St Louis MO 63118 | |
| (314) 865-6585 | |
| (314) 865-6599 |
| Full Name | Jay Mahadevan Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3535 S Jefferson Ave, St Louis, Missouri |
| Authorized Official Name and Position | Jay Mahadevan (PRESIDENT) |
| Authorized Official Contact | 3148656582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jay Mahadevan Inc Po Box 775578 St Louis MO 63177-5578 Ph: (314) 865-6582 | Jay Mahadevan Inc 3535 S Jefferson Ave Suite 304 St Louis MO 63118 Ph: (314) 865-6585 |
| NPI Number | 1386747715 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 08/05/2010 |
| Medicare PECOS PAC ID | 8224153804 |
|---|---|
| Medicare Enrollment ID | O20100920000735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386747715 | NPI | - | NPPES |
| 0400415 | Other | MO | UHC |
| 100656 | Other | MO | BLUE SHIELD |
| 201582608 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jambunathan Mahadevan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669588638 PECOS PAC ID: 1456476043 Enrollment ID: I20100920000972 |
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