Provider Demographics
NPI:1013982818
Name:DIMARSICO, MARY ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:DIMARSICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:STEINKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:660-826-4774
Mailing Address - Fax:
Practice Address - Street 1:1109 W CLAY RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1177
Practice Address - Country:US
Practice Address - Phone:877-733-5824
Practice Address - Fax:888-979-8868
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2F10207Q00000X
MODOR2F10207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010053837OtherRR MEDICARE
MO242215747Medicaid
213038OtherHEALTHLINK
16847OtherBLUE CROSS BLUE SHIELD
876821OtherFIRST HEALTH
876821OtherFIRST HEALTH
213038OtherHEALTHLINK
MO011012090Medicare ID - Type Unspecified