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Organization
WELLCARE MEDICARE
Active
Organization
WELLCARE MEDICARE
Active
Other names
Merit Health Wesley, Wellcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB CORNELIUS PARKER MD, DO (CUSTOMER SUPPORT)
(601) 268-8000
Entity
Organization
Contact information
Practice address
7700 FORSYTH BLVD, SAINT LOUIS, MO 63105-1807
(314) 725-4477
Mailing address
7700 FORSYTH BLVD, SAINT LOUIS, MO 63105-1807
(314) 725-4477
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
—
—
291U00000X
Clinical Medical Laboratory
—
—
305R00000X
Preferred Provider Organization
Primary
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12365433061
CORPORATE OFFICE
MO
01
—
8420042213
ENVISION HEALTHCARE
MS
Enumeration date
01/14/2021
Last updated
11/11/2025
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