Angela M Holbrook, M.D.
Individual provider Active NPI Emergency Medicine Physician · Warrenton, MO
NPI 1790731545 · NPPES record last updated Jan 15, 2009
Key facts
- NPI
- 1790731545
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 103133 (MO)
- Practice address
- 605 E Booneslick Rd
Warrenton, MO 63383-2127 - Phone
- (636) 456-0188
- NPI assigned
- May 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050706000985 | IL | Practitioner - Internal Medicine |
9335185875 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103133 | MO | MD | Pediatric Emergency Medicine (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians of Memphis LLC | Emergency Medicine | Current |
Accepting new patients |
| SSM St. Joseph Hospital West | Emergency Medicine | Past | Accepting new patients |
| HSHS Holy Family Hospital Inc | Past | Accepting new patients | |
| SSM Health Care St. Louis | Emergency Medicine | Past | Accepting new patients |
| SSM Health Care St. Louis | Emergency Medicine | Past | Accepting new patients |
Locations
1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240
Interoperability endpoints
- aholbrook135466@direct.carenet.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 103133 | MO | Yes |
| Pediatric Emergency Medicine (Emergency Medicine) Physician | 207PP0204X | 103133 | MO |
Addresses
Primary practice location
605 E Booneslick Rd
Warrenton, MO 63383-2127
Mailing address
1836 Lackland Hill Pkwy
Attn: Credentialing
Saint Louis, MO 63146-3572
Phone (314) 989-0300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790731545 | Medicaid | MO |
Other providers in Warrenton, MO
- Patricia R Hill
- Nadia Marie Hitchcock
- Amanda Jean Hite
- Sarah Renee Hoelscher
- Emily Hoffmann
- Lindsey M Holthaus
- Lisa Karen Holtmeyer
- Sara Hoover
- Nicole Marie Horn
- Todd Horstman
All providers in Warrenton, MO · Emergency Medicine 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 Jan 15, 2009. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.