Heritage Wellness Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HERITAGE WELLNESS CLINIC LLC

Practice address

2730 S Saint Peters Pkwy
Saint Peters, MO 63303-5677

Phone

(636) 277-9927

Fax

(636) 295-4741

NPI assigned

Dec 19, 2017

Organization subpart

No

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

Authorized official

Name

Kimberly Wyatt

Title

Cred. Spec.

Phone

(636) 277-9927

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abid Nisar, MD

  • Internal Medicine Physician
  • Saint Peters, MO
  • NPI 1245375567
  Medicare reassignment NPD

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513641600000",
    "number": "1619483294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 S SAINT PETERS PKWY",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633035677",
            "telephone_number": "636-277-9927",
            "fax_number": "636-295-4741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S SAINT PETERS PKWY",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633035677",
            "telephone_number": "636-277-9927",
            "fax_number": "636-295-4741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-19",
        "last_updated": "2017-12-19",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CRED. SPEC.",
        "authorized_official_telephone_number": "636-277-9927"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Henderson, LPC
• Daniel Henrichs, PHARM D
• Eileen L Henry
• Kevin Herbert, LPC
• Kari Lynn Hercules, APRN FNP-C PMHNP-BC
• Richard Lee Herman, DDS
• Meghan Hertling
• Marchell Hicks
• Robb R Hicks IV, M.D.
• Ashley Elizabeth Higdon, MA, BCBA, LBA

• Internal Medicine Physician in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.