Emergency Department – Emergency Medicine Physician, NPI 1205967486
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Emergency Department
1515 UNION AVE
MOBERLY, MO 652709407
Phone: (660) 263-8400
Fax: (660) 269-3091
Type: Location
PO BOX 504460
SAINT LOUIS, MO 631500001
Phone: (800) 819-2547
Fax: (423) 296-6006
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-05-17
PECOS data refreshed: 2026-05-27
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65270)
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