St Charles County Dermatologic Surgery, LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

ST CHARLES COUNTY DERMATOLOGIC SURGERY, LLC

Practice address

1493 Cottleville Pkwy
Cottleville, MO 63376-3564

Phone

(636) 317-3376

Fax

(636) 244-1197

NPI assigned

Feb 6, 2020

Last updated

Feb 6, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey S Tull, MDNPI 1467407239

Title

Physician and Owner

Phone

(636) 327-3376

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacey S Tull, MD

  • Dermatology Physician
  • Cottleville, MO
  • NPI 1467407239
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1235761438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 COTTLEVILLE PKWY",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763564",
            "telephone_number": "636-317-3376",
            "fax_number": "636-244-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 COTTLEVILLE PKWY",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763564",
            "telephone_number": "636-317-3376",
            "fax_number": "636-244-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CHARLES COUNTY DERMATOLOGIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "TULL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN AND OWNER",
        "authorized_official_telephone_number": "636-327-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine M. Shiue, M.D.
• Mariela Showalter
• Kimberly Sieli, M.D.
• Susan K. Sneed-Horace, R.N.;B.S.N.
• Jennifer Southward, CPNP
• Scott Thornhill
• Tross Elite Golf Performance and Wellness LLC (Tross Chiropractic)
• Stacey S Tull, MD
• Wendo Home Health Agency LLC
• Caitlyn Elise Wiehe

• Procedural Dermatology Physician in Cottleville, MO
• Providers in Cottleville, MO by specialty
• Procedural Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.