Ameriwound Physicians Mo LLC
Organization Active NPI General Practice Physician · Black Jack, MO
NPI 1538046081 · NPPES record last updated Aug 18, 2025
Key facts
- NPI
- 1538046081
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- AMERIWOUND PHYSICIANS MO LLC
- Practice address
- 13700 Old Halls Ferry Rd
Black Jack, MO 63033-4109 - Phone
- (314) 355-0760
- NPI assigned
- Aug 18, 2025
- Organization subpart
- No
Authorized official
- Name
- Samson Fixler
- Title
- Secretary
- Phone
- (216) 273-9800
Member of 1
Practitioners 2
-
Diana A. Prablek, MD
-
LJ Punch, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251106001612 | MO | Part B Supplier - Clinic/Group Practice | 2668962853 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint Louis, MO; Black Jack, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
13700 Old Halls Ferry Rd
Black Jack, MO 63033-4109
Mailing address
6150 Parkland Blvd Ste 225
Mayfield HTS, OH 44124-4103
Phone (216) 273-9800
Other providers in Black Jack, MO
- A Better Health & Community, LLC
- A Gentle Touch LLC
- Omolara Akinola
- Amazine Health Care Services
- Arm and Arm in Home Care Services LLC
- San Baban
- David Batson
- Beloved Home Services, Inc.
- Best Life CDS LLC
All providers in Black Jack, MO · General Practice Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.