Angela R Menz, NP-C
Individual provider Active NPI Family Nurse Practitioner · Fredericktown, MO
NPI 1619081593 · NPPES record last updated Oct 19, 2018
Key facts
- NPI
- 1619081593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 147218 (MO)
- Practice address
- 611 W Main St
Fredericktown, MO 63645 - Phone
- (573) 783-4111
- Fax
- (573) 783-1065
- NPI assigned
- Aug 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southeastern Emergency Physicians of Memphis LLC
Practice addresses (Care Compare)
1101 W Liberty St
Parkland Health Center Farmington
Farmington, MO 63640-1921
Phone (573) 756-6451
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070323000491 | MO | Practitioner - Nurse Practitioner | 9638273048 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 147218 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Delta Medical Center | Current |
Accepting new patients | |
| Missouri Delta Medical Center | Current |
Accepting new patients | |
| Southeastern Emergency Services of Memphis, P.C. | Current |
Accepting new patients | |
| Southeastern Emergency Physicians of Memphis LLC | Current |
Accepting new patients | |
| Madison Medical Center Stockhoff Memorial Nursing Home | Current |
Accepting new patients | |
| Mercy Hospital Jefferson | Current |
Accepting new patients | |
| Madison Medical Center Stockhoff Memorial Nursing Home | Current |
Accepting new patients | |
| Sikeston Emergency Group LLC | Current |
Accepting new patients | |
| Mercy Hospital Jefferson | Current |
Accepting new patients | |
| Southeastern Emergency Physicians of Memphis LLC | Past | Accepting new patients |
Locations
1403 E Marshall St
Charleston, MO 63834
Phone (573) 683-2327
1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000
1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111
1101 W Liberty St
Farmington, MO 63640
Phone (573) 705-1272
611 W Main St
Fredericktown, MO 63645
Phone (573) 773-7061
1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 147218 | MO | Yes |
Addresses
Primary practice location
611 W Main St
Fredericktown, MO 63645
Mailing address
611 W Main St
Fredericktown, MO 63645-1111
Phone (573) 783-4111
Other practice location 1
1008 N Main St
Sikeston, MO 63801-5044
Phone (573) 472-6001
Other practice location 2
1403 E Marshall St
Charleston, MO 63834
Phone (573) 683-2327
Other practice location 3
1403 E Marshall St
Charleston, MO 63834
Phone (573) 683-2327
Other providers in Fredericktown, MO
- Madison Memorial Hospital Stockhoff Memorial Nursing Home
- Madison Memorial Hospital Stockhoff Memorial Nursing Home
- Madison Memorial Hospital Stockhoff Memorial Nursing Home
- Emily Brooke McCulley
- Christopher M McDowell
- Abigail Louisa Meza
- Midwest Health Group Convenient Care, LLC
- Craig J. Millham
- Modern Mental Health
- Sarah Pauline Mueller
All providers in Fredericktown, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2018. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.