Provider Demographics
NPI:1437277589
Name:MOUND CITY CARDIOVASCULAR CONSULTANTS, INC.
Entity Type:Organization
Organization Name:MOUND CITY CARDIOVASCULAR CONSULTANTS, INC.
Other - Org Name:WENDELL N. WILLIAMS, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-381-4141
Mailing Address - Street 1:11939 MANCHESTER RD
Mailing Address - Street 2:#408
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4502
Mailing Address - Country:US
Mailing Address - Phone:314-381-4141
Mailing Address - Fax:314-381-4143
Practice Address - Street 1:3409 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1127
Practice Address - Country:US
Practice Address - Phone:314-381-4141
Practice Address - Fax:314-381-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3F19207R00000X, 207RC0000X
IL207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherINSURANCE ID-TAX ID
MO=========OtherINSURANCE ID-TAX ID
MOP00254101Medicare ID - Type UnspecifiedRAILROAD MC INDIVIDUAL ID
IL208044Medicare ID - Type UnspecifiedIL MEDICARE GROUP ID
MO=========OtherINSURANCE ID-TAX ID
ILK03110Medicare ID - Type UnspecifiedIL MEDICARE INDIVIDUAL ID